Hi Everyone,

After following on and  off for a few months (and lately set to no-mail) I'm desperate for some leads for my patient.  Here's my brief intro: I'm a breastfeeding consultant of over 9 years working on my certification ---hopefully writing the exam this July, if they let me!!  I work one-to-one with mom's in the Toronto community and refer back to Jack Newman for advice.  I also work with Dr. Newman 3 days a week in his clinics (but technically I'm a volunteer).

Here's the problem:  I have a 41 yr-old multipara who successfully breastfed first 2.  She subsequently had a mastopexy (periareolar incision) with a NIPPLE REDUCTION---not a common procedure.  Mom unexpectedly became pregnant and is desperately wanting to breastfeed.   Baby is now 8 days old.  Mom has been engorged (which we are treating) but there is only slight milk transfer in one duct in each nipple at its base.

Mom is determined and will undergo any procedure and will travel anywhere---money is not an issue---to resolve this problem.  After consultation with her plastic surgeon, we have determined that what is required is a re-canalizatuion of the ducts (the reduction involved slicing the top portion of the nipple off, so that scar tissue has now formed over top) and a way to keep them from scarring over again.  To all of our knowledge and research, this has never been attempted.

Has anyone heard of any procedure of this nature?  Could anyone refer us to a surgeon who might be interested in getting innovative?

Mom is obviously kicking herself for every aspect of this situation, the surgery, the lack of planning/research during pregnancy, the willingness to endure another surgery, etc..  She would like to exhaust all possible solutions before giving up.  To top it all off baby has a heart murmur (not the average nothing-to-worry-about-kind).  One consultant's advice to the mom to stop carving herself up is not only unproductive, but adds salt to the wounds.  We need creativity here and this mom needs lots of support.

Any leads would be greatly appreciated.  Please send directly to my e-mail: [log in to unmask]

Thanks all,

E.



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