This post is in response to a message from Jackie Cesnik on May 24.  It's
taken me this long to get caught up enough on reading messages to be able
to send some!  But I'm not complaining! It's great!

I have a client ( 36 years, primip) with a now 8 month old whom I saw in 1st
week postpartum and had some
occasional phone contact with over the next several months.  She came to
me 2 April when baby was 7 months because she said baby had "nipped" her
on rt. breast and she hadn't fed him there for a couple of days and now
she had a big lump there and baby was refusing.

I palpated the lump and felt it could have been a plugged duct only there
wasn't any inflammation.  I recommended that she use a Lactina pump with
massage following each feeding to see if she could reduce the size of the
lump and to bring the milk supply back up for the baby.

I checked with her about a week later and she said the lump had reduced in
size, the milk supply had come back up to the point where she could
express upto 5 oz. at a time and the baby was nursing on that side again.
It appeared she was making progress so I recommended that she continue
until lump was gone.

One week later, the lump had not changed any further.  The only thing I
could think of was an abscess, even though her symptoms were not typical,
ie.no fever, inflammation, mastitis, etc..  In hindsight, I don't know why
I didn't clue in!  Anyway, I recommended that she see her physician and
ask for a referral to a surgeon re asessment of possible abscess.  I
encouraged her to request ultrasound and mammogram prior to surgery.

Family doctor thought it was a plugged milk duct but referred her to
surgeon.  He said he thought the same but sent her for ultrasound and
mammogram.  These were inconclusive so a biopsy was scheduled for April
28, 26 days after she'd first seen me with this problem.

The biopsy was positive for malignant cells and my client had a modified
radical mastectomy on May 10th.  There was an 8 cm. mass (client was told
>5 cm. was high risk) and the 15 lymph nodes tested were all positive.
Chemotherapy was started last Wednes.(31 May).

A couple of points - in references to malignancies it is often said that
baby will refuse the breast.  Since the baby returned to the breast when
the pumping brought the milk supply back up, it would appear, in this
case, anyway that the baby refuses because of the reduced volume due to an
obstruction.  Jackie had said the MD's were horrified when she suggested
her client continuing to breastfeed until surgery.  My client continued to
feed until day before surgery on "good" side.  She had reduced volume on
affected side gradually with pump from diagnosis to surgery.  She took her
pump to hosp. with her and fully intended to continue feeding until chemo.
was started (initially planned for 1 month post-op.) but following surgery she
was too sore to hold baby so gradually reduced milk volume on good breast
and returned pump 3 days prior to initiation of chemo..  Mother has a very
positive attitude and says she's determined to beat this because she wants
her baby to continue having a mother.  I just hope and pray that she
succeeds.

And I hope I and the MD's involved recognise the problem a lot quicker if
this ever happens again.


--
******Joan M. Fisher, RN, BN, MEd, IBCLC******
***********Ottawa, Ontario, Canada************
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