I saw an article comparing treatments for galactocele where they did a probe through the nipple to remove protein deposits in the duct which worked completely. Some years ago one of our lc's had this problem and saw a breast surgeon who performed this procedure. It worked wonderfully and she never experienced any more problems with plugged ducts or galactocele. Wonder if that's what your loved one needs? As far as flange size - I've noted that sometimes flange size needs to decrease as tissue becomes more flexible and have actually gone down to 21's and found good success. Might check that out. Remember your own information about "forces push". When vacuum is applied to the tissues there can be excessive swelling causing prolapsed of the extraductal tissues into the flange which can in turn slow down milk ejection to the pump. That's why higher but shorter times of expression may be more effective. I always remind moms that babies usually stop applying vacuum during the ejection phase and finish with non-nutritive sucking. If a mom has a large supply, causing a rapid ejection of milk with baby filling very quickly, that mom tends to be more vulnerable to oversupply mastitis.
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of K. Jean Cotterman
Sent: Thursday, August 15, 2013 2:20 PM
Subject: Flange size question, BF friendly MD's + update on great grandson.
Dear "all my breastfeeding friendly friends",
PTP from my granddaughter plus full knowledge of listmothers:
Does flange size ever need to be increased after initial sizing? Standard flanges were very uncomfortable for my granddaughter to start with, and hospital obtained what she says are 33 mm. flanges which have been working well now for 6 weeks. Pumping amount on R. side continues to yield 5 oz, while L side is now "only" yielding 3 ounces, breast still feeling full, she "has to massage" and then "can pump 2 more ounces". I figure she has triggered another MER, but because of the change in pattern, I wondered "Does flange size ever change, say to a need for a 36 mm. on one side?" I wonder about overproduction and its dangers (q. 3 h. except at night when she lets breast wake her up), but OTOH, I don't want to mess with her success!!
Separate question re: breastfeeding friendly breast surgeons in or near Charlotte NC? "Lump" on R. side (the 5 oz. side above) present since 7 months pregnant, OB said then it was "probably a cyst". Now after pumping for 6 weeks the "lump" continues to cause her discomfort despite (gentle!) massaging before and during pumping, between in the shower, etc. Makes me concerned this might raise risks for plugged duct, mastitis etc. I have encouraged her to start lecithin. Since long-term lactation is wanted, I would like her to consult a breastfeeding friendly breast surgeon in or near Charlotte NC for possible US testing etc., and I don't want her to have to "fight" about weaning before testing, etc.
My great grandson is going to receive his anuplasty surgery next week, and when that heals, he will have his colostomy reversed some weeks later. Further diagnostic testing has now given an added diagnosis besides heterotaxy with asplenia. Links below. Of course, all this has changed all her plans about returning to work, and she will happily be a SAHM with him, for many reasons.
If you want to know more about his situation, I have posted these links below. All prayers and good wishes appreciated.
http://www.ojrd.com/content/6/1/56
http://www.ncbi.nlm.nih.gov/pubmed/16113522
https://www.facebook.com/DemayneJr
http://www.gofundme.com/3tq9js?preview=
K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC Dayton OH
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