On 17/3/04 7:44 AM, "Automatic digest processor"
<[log in to unmask]> wrote:

> I am attempting to help a mother with a post mastitis situation and thought
> that perhaps some of you have helped with a similar one. The mother is a
> physician with her first baby, (who is breastfeeding well and thriving). Both
> breast
> were the same size and we felt were producing approximately the same amount
> of milk until three days after the start of a mastitis. I would like to
> suggest
> ways to increase her breast milk supply from the affected breast with
> fenugreek (she has been feeding more frequently from the affected breast in an
> attempt to increase the supply) but I
> am concerned that the unaffected breast will start oversupplying. She sent me
> the following description of what has happened and would also like to hear
> from you. I will be forwarding all information to her and this is sent with
> her
> permission.
> Thank you very much,
> Nancy

During mastitis there is an increase in breast permeability in the affected
breast which is quite variable amongst women. Some women will experience
quite substantial increases in paracellular pathway permeability whilst
others do not, or if they do, they may be only transient. If there is a
large area of increased permeability over a sustained period of time (days)
a large amount of lactose can be lost from the milk space into the
interstitium, which results in a significant drop in supply (as lactose is
the major osmole in milk which maintains milk volume). In addition to this
there is also likely to be some inhibition of lactose synthesis in the
affected (inflamed) lactocytes. And further to this, research in cows has
shown that mastitis also induces apoptosis (programmed death of cells) in
the healthy cells in the gland affected, which may also happen in women. The
combination of these influences can result in quite a substantial loss of
supply in the breast affected by inflammation. The contralateral healthy
breast will of course increase in supply at this time in response to the
infant's increased demand from that breast. This leads to a substantial
change in the appearance of the breasts.

I have also observed the sequelae described by your mum in quite a few
mastitis patients

>over the next three days I noticed that there
>was a large (5-6 cm) lump in the upper-outer quadrant of the left breast, and
>that the remainder of the breast was very soft and empty-feeling

These lumps can persist over a long period (I have seen up to a year) and
will atrophy over time. It is difficult to know exactly how and why they
form in some women and not others. On ultrasound they may have the
appearance of a cyst or resolving abscess or an inflammatory lesion. However
aspiration of the contents is not +ve for microbial growth (usually just
milk cells and general tissue and milk debris) . They should just continue
to be monitored and be allowed to involute naturally. Supply in the affected
breast can be restored over time however for some women this is difficult
and they just go predominately with the other breast.

Regards
Cathy Fetherston
Perth, Western Australia

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