Barbara wrote:
< Also, it's my
impression that the surgery has begun to be more careful with regard to
protection of the function of the breast. !5 years ago when I saw my
first
cases, the breasts were just not delivering milk to the outside; today, I
see many more successful experiences.>
Let's hope this is the trend. I saw a mother yesterday who commented
early on in the consult that she had asked her surgeon what would happen
if in the future she should have a child and decide to breastfeed.
His answer: "I didn't interrupt anything. I think you should have no
problem." I hope he was referring to lymphatic pathways as well as nerve
and ductal pathways.
Thus far it appears he's right. Only problems are the usual ones related
to IV's/pitocin induction/use of a breast pump on maximum setting=edema,
especially noticeable over the areola.
In searching for references recently, I found this interesting one. It
semi-confirms my impression that vacuum, used on higher settings in the
early postpartum period, in hopes of "getting out some milk", can
actually encourage extra interstitial fluid to migrate into the area
covered by the pump flange.
Could this be in large part responsible for "areolar edema", and
compounding problems such as "temporary flattening of the nipple" and/or
a "thicker, tougher, more resistant areola"?
Hamann J, Mein GA, Wetzel S. Teat tissue reactions to milking: effects of
vacuum level. J Dairy Sci 1993 Apr: 76(4): 1040-6
From the abstract: "We suggest changes in teat length, diameter,
thickness and compressibility after milking at low vacuum levels mainly
reflect tissue responses to udder evacuation. In contrast, increased teat
wall thickness and reduced compressibility of teat tissue at higher
vacuum levels likely result mainly from machine-induced edema."
Let's not forget, while we are raising the hue and cry over IV's, pitocin
induction in particular, and epidural anesthetics, to exam our nursing
care/LC policies on the appropriate use of vacuum vs. the use of "the
pumps at the end of our arms" during the postpartum period .
In particular, I hope researchers definitely include this among the
variables when they publish on nipple problems.
Jean
***************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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