I am working with a breastfeeding mum whose first baby received breastmilk exclusively but not at the breast (despite extensive efforts including multiple lac consults, CST, chiropractic, and work with speech-language pathologist with specialized training in suckling/feeding disorders).  Anyway, this mother pumped for her firstborn for 14 months.  During the course of that time spent pumping, she developed cracks in her nipples which she says "never really went away until she stopped pumping."  At that time, they healed (i.e., closed), but appeared to have scar tissue over them.  (A ring of differently colored, differently textured skin where the cracks had been was left at the base of each nipple, at the juncture point of the nipple to the areola).  
   So, now baby number two is here and (thankfully) is a great nurser.  Nice wide latch, comfortable once the initial pain of latching him occurs, and he's gaining beautifully.  Here's the problem.  This skin at the base of both nipples, which I'm calling scar tissue (in part because it's what the mom calls it, and in part because it truly does NOT look like the rest of the skin on either the areola or the nipple- I have NEVER seen skin like this on anyone's nipples before), has cracked open once again, and despite every effort, does not want to heal.  (Have repeatedly ensured that the latch is excellent, deep, wide, asymmetric, which it is, have tried APNO, Lansinoh, following recommendations for "moist wound healing," GSE topically as well as mom taking orally (no sign of thrush in baby, and no improvement of cracks or pain with use), and a 14 day dose of antibiotics in case it was a staph or other bacterial infection causing these cracks which refuse to heal).
   So, wise folks of Lactnet, I've come to the conclusion that possibly there are some characteristics of scar tissue which are different than "regular" skin that are playing into this refusal to heal.  This is ONE DETERMINED momma, and she continues to nurse this sweet baby on demand notwithstanding VERY formidable cracks at the base of each of her nipples.  She reports that the pain is manageable after the initial latch (which is clearly quite exquisite), but this is coming from someone I know to have a VERY HIGH pain threshold.  ANY insights about how we might achieve healing of these cracks which appear to be on scar tissue would be VERY welcome.
   Thanks (PS., i have photos of the nipples/areolas if that would be helpful - the mother has agreed to my sharing them with fellow IBCLCs to try to come up with a solution) - Aimee, IBCLC in Virginia

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome