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Subject:	Difficult case - inverted nipples
From:	"Dr. Leeper" <[log in to unmask]>
Reply To:	Lactation Information and Discussion <[log in to unmask]>
Date:	Wed, 15 Oct 2008 08:31:37 -0500
Content-Type:	text/plain
Parts/Attachments:	text/plain (26 lines)

These moms often need to pump with very large breast shields/flanges...have
you tried the 30 or 36 mm medela shields?  Or "Pumpin Pals" in the large or
extra-large size might work. Using a pump should also help to evert mom's
nipples, making it easier for baby to grasp. This eversion often breaks
adhesions and produces raw tissue that needs to heal by secondary
intention.  If so, she would need to wear a breast shell between feeds while
awake to hold the area(s) "open".

If mom has been hand expressing, she can show you where the ducts are.  Then
you can estimate whether baby can reach them.  He may need to grow larger.

Kathy Leeper, MD, IBCLC
Medical Director, MilkWorks
Lincoln, NE

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