In a message dated 4/29/1 9:33:22 AM, Diane W writes: << What's different about my current client is that she nursed a previous child for 8 months. She had a miserable first month or so, and she can't remember what her nipples looked like before or after that child. When I saw her at 2 weeks with this baby, she had flat, dimpled, fissured nipples - much like those cloth models with the string pulled tight - and we've been unable to clear up the thrush-like splits that occur with each nursing. So we're going with shells and APNO, trying to heal those splits without having their edges come back together. I have my fingers crossed, because thrush remains a possibility. Has anyone else seen anything like this? Are there any better explanations/treatments/names? >> seen it, yes. regarding explanations for the mom you are currently working with, variables may include: 1) the recent lactnet discusssions regarding variations in breast development with each pregnancy, ie: for the mom you are working with, her current nipple variation may be a more involved variation of her previous nipple anatomy, combined with the possible thrush issue this time.... 2) something may have happened during or after the last pregnancy/pp to increase the severity of the variation she previously noticed: <<Bilateral or unilateral nipple inversion is most often congenital in origin, but can also be acquired. Ductal mastitis in early development prevents the normal elongation of the ducts, or can result in scar tissue that in time retracts to invert the nipple [Schwager 1974] The acquired group also includes breast surgery such as reduction mamoplasty, repeated inflammations [Megumi 1991], carcinoma, tension caused by large penulous breast, [Schwager 1974] and trauma or inflammation following pregnancy and lactation. This places the inverted nipple on a plane beneath the areola, hidden in a sulcus from which it can usually be extracted.[Hauben and Mahler1983]>> 3) also, according to some literature, as *nulliporous* women age, their nipples may become more inverted/retracting due to tightening of the ducts under the areolar tissue, maybe this is also the case with *multips* but it just has not yet been documented/researched.:<<Slit-like retraction can be the result of duct ectasia as the subareolar ducts dilate and shorten during involution which in nulliparous women begins sometime after age 30.[Dixon 1994].>> Regarding treatments, other than what you are doing - medicating the wounds and shells to maintain a protracted position for healing, another treatment I've read about, but not found the occasion to advocate for, - and it seems way too drastic for your situation, and most others, - is surgery to correct severe nipple inversion/retraction to facilitate breastfeeding. I've read that in certain situations where the mom is absolutely unable to breastfeed due to the severity of the nipple anatomy variation, she may choose to have surgery before the next pregnancy. I would expect that it would take a very breastfeeding knowledgable surgeon to produce a sucessful outcome. Depending on the nipple anatomy, with cooperative areolar tissue, and with a motivated, dependable, client, the dimple rings may keep the protracted postion better than the shell... and, Nipplette also comes to mind as a device to keep nipples protracted, but .... expensive, not easy to use, no air circulation...... In your current case, since in the mom's previous experience her condition improved after a month, and even if her condition is worse this time, if she will continue with your support, it is likely that she will experience improvement. Debbie Tobin RN BSN IBCLC LCCE Springfield, Virginia USA In the Fairfax County suburbs outside the Washington DC beltway [log in to unmask] *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html