Sorry Lisa, I got my lefts and rights mixed up... it was the RIGHT breast
that had the whole periareolar incision as it had been relocated, and the
LEFT (the one with no MER) that had the partial periareolar incision and
had not been relocated, simply partly lifted to insert the implant. That's
why I found it surprising that the left one had apparently lost more
innervation.

I did not do pre-post feed weights, but the left breast, once MER was
elicited by briefly suckling on the right, started spraying, and then baby
latched and was gulping with a steady suck:swallow:breathe 1:1:1 pattern,
with prolonged sucking bursts. So I am sure those ducts have integrity.
Same good transfer went on at the right breast.

I did not test skin sensitivity on nipples/areolas (duh, what was I
thinking?) so I will be sure to do that next time, thank you!

I´ll keep you posted.
Kika



>
> Date:    Sat, 10 Apr 2021 14:39:10 +0000
> From:    Lisa Marasco IBCLC <[log in to unmask]>
> Subject: Re: Milk ejection reflex and breast surgery
>
> Hi Kika!
>
>
>
> I think we are missing the details on why the surgical trauma to the left
> nipple/areolar complex is less than that of the right... it sounds like
> both sides had peri-areolar incisions but the left additionally had been
> incised completely around the base of the nipple in order to be
> re-positioned. That last put the ducts at risk, but you are reporting that
> once MER occurs, the baby is able to extract milk well from that side. I am
> curious as to whether a pre-post feed weight was taken to document the
> relative removal of milk from each side? I know you said "great milk
> transfer."
>
>
>
> On eliciting MER with latch on the left... I am wondering if the
> nipple-repositioning created some scar tissue and nerve irritation that
> makes that whole side more sensitive and prone to stretching pain. Such
> noxious stimuli, and/or the anticipation of it, can certainly inhibit the
> letdown reflex. The fact that once MER is stimulated from the other side
> the left side can be fed on comfortably is telling. Do you happen to know
> if touching/pulling/stretching of the left nipple is uncomfortable vs the
> right? Does she have equal sensitivity to touch (no numbness) of each
> nipple?
>
>
>
> In the meantime, you've hit on the best strategy- get MER going by an
> alternate method. Perhaps a little light massage, stretching and expressing
> of the left side to get milk flowing first would also be helpful.
> Alternatively, she could keep doing what you tried- start on the right then
> switch quickly to the left.
>
>
>
> I suspect that once you've both settled on a successful strategy, that
> conditioning will set in and she will start to have the common experience
> of anticipatory letdown prior to latch that should also help this along.
>
>
>
> Let me know which of this resonates and which does not!  I love a good
> challenge. 😊
>
>
>
> Lisa Marasco
>
>
>
>

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