Your cases are quite interesting. As a new LC, I am seeing a fair amount of TT as well as failure to thrives who were not assessed earlier for TT or did not receive follow up following a tongue tie release. 

But this what I have learned: The lesions on the nipple could be from the baby or if mom is using a nipple shield from the tight bite/suck on the nipple shield. I have a case like this and because the infant was not latching deeply and properly on the nipple shield, it looked like lesions had formed on the nipple where it meets the breast. (supply was also impacted). In this same case, the mom also reported amazing pain during breastfeeding and after (baby was 6 weeks of age at the time). Baby had already had tongue tie clipped. Labial tongue tie looked to be present and mom reported this was not assessed during clipping. Mom was encouraged to return to MD for assessment but has not done so. In any case, thrush protocols were begun based on visual appearance of breast and mom reporting stinging after breastfeeding. 

But,  the big impact on healing and resolution (or sort of) and protecting milk supply, came from renting a hospital grade pump and bottle fed for three weeks (sorry...but this is what we did). This allowed for the nipples to heal, positive bonding to take place with baby, and supply to increase.  After 3 weeks of healing and bonding, mom put baby back to breast. This was done both with and without a medela nipple shield. But once again terrible pain was reported (this baby loves to breastfeed :(, no latching on breast problems just latching without pain and deeply problems) 

After some brainstorming, I had mom use an avent nipple shield and breastfeed for snacking only. This achieved a breastfeeding with no pain, and the most amazing look on mom's face...what BF doesn't hurt?. I do not know if it is because the avent nipple shield is a little thicker (I discovered this from an NICU mom who loved this shield because it took away her pain and stayed on the breast better) or because the snack suck is less strong, but positive breastfeeding did occur.

But, without a labial tie assessment or a re- assesment of the original tongue tie mom found it too painful to breastfeed for meals. She is now an exclusive pumper.

So...not sure if this helps or not but the avent nipple shield, feeding for snacks, and hospital grade pumping for nipple healing, might help to bring some non-painful breastfeeding sessions your way. 

Best Wishes,
Lisa Weinshenker, RN, IBCLC
Las Vegas, NV

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