><intussuscepted nipples>
>
>Diane! that sounds like a term someone like me would come up with! Tell
>us more, and where did you get the name? In Paris, by chance?

Ha!  It really is a term, and I figured *somebody* would ask about it, most
probably Jean Cotterman, our Nipple Queen.

Chele Marmet probably coined the term; I've not seen it in any other
literature.  In her book, "Lactation Forms: a Guide to Lactation Consultant
Charting", she writes about "adhesed nipples:  Dimple, folding, and
intussuscepted nipples are glued or adhesed together (skin glued to skin)
with bodily secretions at some point along their surface.  When the newborn
begins to breastfeed, the nipple is pulled away from the skin to which it is
adhered, leaving the skin raw and sore.  Since these nipples are often also
mildly inverted, they may also present a graspability problem.  The mothers
often complain of bleeding nipples which is a clue to one of these three
adhesion problems.  The primary treatment for all of the adhesed nipples is
to use a lubricant to massage and manipulate the nipple out.  Then it is
held out in the exposed position..."  She has photos, but you know how
photos are...

I'd have described it differently, from my *very* limited experience with
them:  It's as if the inner nipple is capable of greater extension than the
skin containing it, and the skin must either split anew every time the
nipple is stretched, or new skin has to form to fill in the splits.  Hold
your fingers in a loose fist and lay your thumb straight and tight against
your index finger.  The crease between thumb and hand/finger is where the
split occurs and re-seals.  Now roll your thumb away slightly, and a space
opens up.  That's what the wound is like when it's "open".  Get the skin to
heal in this new position by filling in that space with new tissue, and the
nipple takes on - permanently - a new expanded shape.  In each case that
I've seen, once the woman healed, her nipples were noticeably different in
shape and problem-free.

Chele has created a velcro "dimple ring" to hold the center of a dimpled
nipple in an exposed position; when the splits occur along the nipple shaft
(which is all I've seen), breast shells seem to work well.

I've seen it maybe 4 times in 16 years:  The first time we just couldn't
figure out why this mother wasn't healing.  Every time she nursed, her
nipple tore.  With shells and antibiotic ointment, she finally healed, but
with a longer nipple shaft than before.  No problems at all with her second
child.  The next time was a woman pregnant with her second, and fearful.
She had spent many months healing with her first child though she had gone
on to nurse comfortably.  She could show me where the "new" skin was on her
nipples.  No problems with her second child.  The third was a woman who
seemed to look like what had happened with the other two.  A few days with
shells, and she healed in her new shape.  There was a fourth whose extremely
flat nipple became more protractile in the first week of nursing/pumping,
but then the tip sort of everted like a flower opening and became raw and
sore.  Once it healed - again, in the "open" position - she had a more
distinct nipple shape and no further soreness.

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?

Diane Wiessinger, MS, IBCLC  Ithaca, NY
www.wiessinger.baka.com

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