Hi everyone,
  I'm trying to work with a first time mom who had bilateral breast
augmentation surgery twice. On both occasions the surgeon used
periareolar incisions inserting saline implants in non silicone bags.
If you are unfamiliar with this type of incision, it extends from
approximately 3:00 to 9:00 at the areolar margins.  Her plastic surgeon
(from another state) assured her at the time that she would be able to
breastfeed.
  And in fact, her baby, at 6 days of age is gaining weight very well,
is alert and excreting appropriately. The problem is that the mother has
developed engorgement that is unrelieved with feeds, specifically the
lower half of the breast which is reddened. She has also developed
tender, firm masses in the axillary regions, the right side is
especially large - approximately the size of a plum.  She remains
afebrile but complains of headache, malaise, and presents with a fine
red rash over most of her torso.
  I believe she has milk stasis due to interruption at the outlet post
surgically, but we discussed standard treatment of plugged ducts and
mastitis.  I, of course spoke with her obstetrician and he was to see
her in his office.  He did say that he would recommend that she stop
breastfeeding gradually, which I must concur with since I know of no way
to manage this otherwise.  And of course she very much desires to
breastfeed.
  As I have posted before, we serve a large rural population and have no
specialists that I could refer her to.  I do know that this particular
type of incision puts her at great risk for lactation failure but
thought that I would ask your help.
  Thank you
  Katherine Abdun-Nur RN CLE
  Breastfeeding Support Services
  Grants Pass, OR