Hello,
Hopefully someone has heard of this situation and can offer answers.  I'm a 
hospital based IBCLC and have the patient's permission to post.  Mom is 1 day 
post vaginal delivery, 32 wks gestation, NICU baby.  

Describes very painful montgomery tubercles.  Needs to pump but cannot 
tolerate pump flange even lightly touching areolar skin.  Nipples are sensative 
but not to the extent of montgomery tubercles.  

Areolar skin appears very smooth until lightly stimulated then raised areas 
form. After a couple minutes the bumps look like normal montgomery tubercles 
and the pain intensifies.  Skin color of raised areas become lighter but does 
not appear to blanch.  No history of Raynauds.

Pain has been present for the past 5 yrs and was intense pre-menstrually then 
susbsided once menstration began.  Pain increased during this pregnancy.  

Mom reports a history of frequent yeast infections with one occurance treated 
early in pregnancy.  Nipples and areolas were dry and flakey during 
pregnancy.  Mother denies nipple burning, shooting, or itching.  

There is no history of medication use that might cause nipple pain.

Applications of heat or cold prior to pumping have not decreased the pain 
level.  Lowering the pump pressure setting has not decreased the pain either 
because it is a skin senstation issue.

I have suggested a possible systemic yeast infection.  But why for 5 years 
and why mainly in the montgomery tubercles?  I have recommended an 
immediate appointment with a dermatologist.

The montgomery tubercle pain throws me.  Is there something I've missed?

Thanks,
Brenda Rockers, RN, IBCLC
Conyers, Georgia

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