I recently worked with a mom who had had 2 breast surgeries (lumpectomies,
actually, in 2 different quadrants of the same breast); she experienced a
course, in the early days, similar to what you describe with the mother of
the 33 week twins. I first saw her on day 4 pp; she was *miserably* engorged
on the affected side, and was pumping both breasts but was getting not a
drop from the surgical side. My spirits sank, and I was quite worried about
her prospects of getting that side going at all, but the next day her doula
came and did a very deep massage on that breast, combined with ice (and no
warmth - I had been telling her to use both, depending on before/after
fdg/pumping) afterwards. Initially after the massage, she had no results,
and went to bed (crying!)for a long nap. When she woke up, she was able to
pump milk from that side, and by day 7 was producing about equal amounts on
both sides. I've never been so happy to see 2 oz. of milk! I think there was
deep internal engorgement, possibly with some adhesions or scar tissue
blocking the ducts, and that they were loosened or opened up by the massage.
The warm compresses were clearly just aggravating the swelling - once she
got the swelling down & the passages open, she did pretty well with that
side. (Not a long-term "success", however - but that's another story...)
As to the twins aspect - I would never doubt the body's ability to produce
adequately unilaterally, if that's what turns out to be necessary. But don't
give up on that surgically-affected side yet! The trick, of course, is to
keep a good supply stimulated till the way seems a little smoother; but
you'll help her handle that with pumping, etc. Just get her started ASAP,
watch the babies, and I bet this will come out all right.
Cathy Bargar RN, IBCLC Ithaca NY
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