The history of tongue tie, lack of compression stripes, and continued
pain and edema despite treatment with antibacterials and antifungals
makes me think that the issue might be bruising from the babies' gums.
Some infants with tongue ties use excessive jaw compression to remove
milk, and their little gums leave bruising on mom's areola.  This is
very painful, can cause edema in the overlying skin, and makes pumping
painful too.
If one or both of the babies has a hypersensitive gag reflex (which some
tongue tied kids do, I suspect the lack of stimulation to the palate
makes it naive and unused to tactile stim...), they will latch more
shallowly, compounding the situation.
An extremely asymmetrical latch with the baby's head extended can reduce
the biting or gnawing.  A few days of fingerfeeding with the finger in
the correct position in the mouth, and the fingertip being directed
downward against the tongue every time the tongue is retracted can make
a big difference.  Mom might be able to tolerate pumping better if she
has the very largest flange, and uses the pump on the absolute minimum
vacuum.  Soothies or ice/warm packs on the areola might help with pain
relief as well, as well as NSAIDs.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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