Dear Wise Ones,
I have searched the archives and every book I have to find out more about a situation I encountered and turned up nothing.  A 7 day post partum mom came to me for an outpatient visit complaining of "excruciating pain in the veins of her areola".  I suspected a varicosity, plugged duct, blocked pore, nipple vasospasm, or just plain old engorgement.  On exam mom's breasts were full but not engorged, no palpable masses, prominent veining, crescent-shaped scabs over both nipple tips.  The veins she described as causing the pain in the left breast were slightly raised and looped into the areola exiting at about 1:00 and 3:00 and another less prominent loop visible at about 4:00 and 6:00.  She showed me how she had been feeding baby--shallow latch, usually in the football hold. We corrected the position and got a deep off-center latch in the cradle hold with mom wincing but definitely more comfortable.  The baby's upper lip just grazed the upper loop and didn't touch the lower loop in the
 cradle hold.  As the feeding progressed the vein became more and more dilated and more painful.  Milk transfer was good, nipple was still slightly pinched after feeding and pale just at the tip but rapidly returned to pink.  The veins remained dilated and the pain persisted for several minutes after the feed.  We corrected the latch on the other breast and had a pain free feeding.  Mom previously had premature twins for which she pumped for 5 weeks but then quit due to the same pain.  She was looking forward to actually breastfeeding one baby and is getting very discouraged already.  I suspect the pain will improve in time with the corrected latch and different positioning.  I referred her to her obstetrician to see if maybe a vascular consult was in order or a cosmetic surgeon.  I know that veins can be injected and sclerosed but would that compromise the circulation to her breast and interfere with her ability to breastfeed?  This is a new one for me and I'm hoping someone else
 has seen this and knows how the problem was resolved.

Linda Anderegg, RNC, IBCLC in Chicago


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