I have seen this lowered output following mastitis so frequently that  
I would call it a "norm."  Early onset mastitis, that does not follow  
a nipple wound,  is common in the women I've seen with oversupply  
syndrome.
Did mom's description (she could feel it almost coming up toward the  
skin)  sound like near abscess to you? It did to me.  If not, it was  
pretty close. So you may be right regarding involution of a portion of  
lactating tissue.
I have seen the reduction in milk supply following mastitis take  
several weeks to come back up. The area can stay tender for a month or  
more in some moms (they say it "feels bruised"). Many women have told  
me that their milk supply never seemed to return to previous levels.  
Also, based solely on clinical observation and subjective evaluation  
from moms -- return of supply appears to be related to the extent of  
the mastitis. Small area of infection fairly quick return;  large area  
(usually involving an entire quadrant of the breast) supply does not  
return to previous levels. (Good idea for a research project.)
Personally, If she developed the mastitis from milk status due to  
overproduction, I'd use caution with anything that increases supply  
(beyond stimulation and milk removal).  She could develop mastitis on  
the "good" side.
Your idea to have the baby start on the affected side first would only  
work if the tissue has not involuted and the baby cooperates.  
Otherwise she may want to let the baby fill up on the good side and  
finish on the affected side. She will be lopsided and that side could  
potentially involute completely. Just inform her of her options,  
risks, and let her decide what works best for her and baby.
I  remind moms that women have 2 breasts because we occasionally have  
twins. If one side "dries up" she should be able to meet the baby's  
needs on the good side.
I had a mom with only 1 breast (mastectomy) exclusively breastfeed  
twins for 6 months and went on to breastfeed them for a year. She was  
an ample producer but was "forever feeding babies" during the first  
few months to make sure they both got enough.

Marie Davis RN IBCLC

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