I remember when studying for IBCLC exam, One of the courses I took mentioned "raspberry nipples" that looked like the photo you've posted. But I can't recall their significance. Wonder if anyone else has the same opinion and possible solutions.
Melinda Harris-Moulton ARNP, I B C L C
Olympia, WA
Sent from my iPad
> On Sep 4, 2014, at 12:16 PM, Leah Roy-Ehri <[log in to unmask]> wrote:
>
> Hello!
> Case study for H.R., 2nd time mom with previous and current unusual nipple
> pain and damage. Mom has given permission to post. Has anyone seen this
> before or have thoughts on how to treat this?
> I cannot post the very helpful pictures here, but you can e-mail me at
> [log in to unmask] and I will send you the attachment, or you can go to
>
> https://drive.google.com/file/d/0B0dBKhEyYLmVWGhva2dCYVpxUzcxWXRPeUZzLXpQSzUyQkdj/edit?usp=sharing
> for
> pictures and full history
>
>
>
> Brief History:
>
> H.R. had her 1st baby 11/25/11, Charlie.
>
> With Charlie, mom had significant latch issues, milk supply issues and
> nipple damage.
>
> Nipples got breadcrumb like “flakes” that built up and then came off. There
> was raw skin left when they came off. Mom had blisters over the entire
> surface of her nipples at times. By 5 months, the damage was so severe that
> her very breastfeeding-supportive MD encouraged her to stop breastfeeding
> and pumping, and everyone involved in the case agreed.
>
> Currently, mom has twins, born at 32.5 weeks on 08/11/14.
>
> Mom is pumping, getting excellent volumes of milk, but having nipple pain,
> same breadcrumb like flaking and blistering.
>
>
>
> The blistering does not happen every time, and is only on the left side
> with these babies. With Charlie, it did happen on both sides. The blisters
> are on the sides of her nipple as well, and extend into a deep crevice on
> the outer aspect of the nipple.
>
>
>
> Nipples hurt significantly when exposed to air, so there is pain before
> pumping, and immediately after pumping. Right nipple has area in left
> lower quadrant that turns bright purple with pumping.
>
> Mom reports that there is a blister-like appearance over the entire tip of
> the nipple immediately following pumping at times on the left side. Mom
> continues to have flaking of both nipples that is breadcrumb like in
> appearance. Flakes “build up” over a few days, then flake off, and skin
> left behind is reddened, like an excoriated area.
>
>
>
> With less pain medication, mom is noticing what we believe is vasospasm
> more. After pumping, when moving from hotter upstairs right after pumping
> to colder downstairs pain gets worse. Pain lasts for 30 minutes or more
> after every pumping session. Total of 4+ hours of significant nipple pain
> a day. Pain after is way worse than pain during pumping. Pain during
> pumping on low suction level is 1-2 during pumping (on 0-10 pain scale).
> Pain after pumping is 4-5 for 30ish + minutes. It is a constant pain and
> is distracting consistently. Nipples stay erect for entire time pain is
> present. Mom describes nipple pain as “throbbing, burning.”
>
>
>
> Mom has nipple pain with towel brushing against nipples, anything touching
> nipples. Any friction on nipples is excruciating.
>
>
> Mom pumping enough volume, but was spending 40 minutes total pumping. We
> revised the pumping plan and she is now spending about 30 minutes. The
> issue is that mom cannot turn the suction up high enough to get a fast
> enough flow to finish in 15 minutes without severe pain. Milk drips slowly.
> Mom has observed sprays with increased suction, but this is intolerably
> painful.
>
> Thank you for any thoughts you may have! This family had quite the
> infertility journey as well as the challenges with their 1st and twins. We
> would love to see breastfeeding be easier for them!
>
> Leah Roy-Ehri RN,BSN,IBCLC
> Ann Marie Neely BA,IBCLC
>
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