You're right that breast pain can be difficult detective work. The 
breast is packed with nerves that wrap around the body and can cause 
referred pain -- a problem in an adjoining muscle or joint is felt in 
the breast, or  breast pain can zap around to the person's back, or up 
into the underarm.   Your client describes an intense "pulling" 
sensation, which sounds like a nerve response -- perhaps radiating from 
a muscle pull or a post-feed/pump "nipple vasospasm" with or without 
blanching, https://kellymom.com/bf/concerns/mother/nipple-blanching/

Since the pain went away, it seems less likely to be any kind of 
infection, where pain might ebb and flow, but is always kind of present.

When a nerve pathway fires, it's reinforced -- it's easier to go down 
that path again.  The idea of "mammary constriction syndrome" seems 
related to vasospasm,  and the the home-care for either idea aims at 
keeping the breast and chest warm, the chest muscles loosened and 
relaxed, and the blood flow high, to head off the nerve reaction before 
it happens, so the body forgets about that pathway   Try applying dry 
warmth after feedings/pumpings, doing breast and chest-muscle massage a 
few times a day, pectoral stretches in a doorway.

And discussing her pumping technique, flange sizes, suction levels, and 
perhaps revisiting what the baby is doing at the breast.  (In the modern 
world, we expect these cave babies to go back and forth between breast 
and bottle, but sometimes mothers need to revisit helping their older 
baby get a deep latch that doesn't stress the nipple).  And discuss her 
body mechanics -- sometimes, particularly when mothers are working on 
latch, they hunch forward, attach the baby, and rigidly hold a tight 
body posture, every muscle taut.  Even with pumping, mothers can hunch 
forward and watch every drop.

If the pain is ongoing, you may be looking for more ideas.  If you 
google "breast pain algorithm" you'll find a great flow-chart by Alison 
Steube that gathers together common and uncommon causes of breast pain.  
She's also one of the authors of this well-referenced Academy of 
Breastfeeding Medicine protocol.

https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/26-persistent-pain-protocol-english.pdf

Good luck to all.

Margaret Wills, IBCLC Maryland USA


> Date:    Tue, 7 Apr 2020 23:24:11 -0400
> From:    Hadassah Mann <[log in to unmask]>
> Subject: Question about interesting breast pain
>
> A client shared the following symptom. The "snap" part is throwing me off. any direction? History of breast abscess, but none now
>
> Noticed some “strange” issues on the left side. I had that weird sore spot which lasted about 24 hours.. seems to have resolved but at my 5:30 pump when I unhooked the right side the left side has this pulling pain all the way up into my armpit. Luckily I was almost done and I was able to stop before it kept progressing but it has caused me to feel sore up in that area. It was a weird pulling tingling feeling that something in there could snap. None the less it did not feel right. I don’t feel any lumps in that area. Any thoughts?
>
>              

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