Megan asks if there is some relationship between inverted nipples and breast
drainage problems severe enough to produce abscess.  Yes, sometimes.  I've
seen two cases of inverted nipples where there were only deformed looking
"polyps" down inside the crevice or slit in the breast tissue where a nipple
ought to have formed.  Ruth Lawrence was in town on one occasion and was
kind enough to look at my client.  Ruth described the woman's situation as a
"congenital birth deformity".  If the woman had not been pumping to keep her
breasts drained (the infant couldn't latch and none of us knew enough about
nipple shields back then to suggest one) she might well have suffered
profound engorgement and progression to abscess.  If there is a less severe
problem, but the nipple inversion interferes with baby's ability to latch,
the baby may compensate by clenching, causing cuts in the nipples and
exposing the interior of the breast to refluxed bacteria that ride to the
interior of the breast on the ebb flow of the letdown reflex.  If that
bacteria is dragged up into the breast and sits there in a poorly drained
lobe, they can certainly multiply -- esp. if the mother's immune system is
weak from typical postpartum stress.  Also, although I don't recall having
seen this be studied explicitly, I would suspect that some nipple
deformations may well be markers for glandular development that isn't quite
normal.  This might well affect drainage patterns and set up more risk for
inflammatory issues.

Abscesses are a complication of both profound engorgement and mastitis.  If
an abscess "ripens" as a boil does, opening to the surface of the skin, this
might well be proceeded by an erruption or puckering of the skin such as
Megan describes.  The medical care can involve needle aspiration of the
material inside the boil (often needs to be repeated several times) or
incision and drainage.  Antibiotics are prescribed, but alone won't solve
the problem as an abscess is, by definition, a walled-off cyst.  The meds
can't penetrate the cyst and kill the germs, so the mass has to be removed
or collapsed (by aspiration) first.  What you don't want is for one of the
deep boils to burst internally and spread sepsis.  Not only can this make
mothers very sick, it causes a lot of damage due to creation of scar tissue.
Most good breastfeeding texts (not ones for parents but the ones for
professionals) have sections on abscess.


Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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