I have a client who had a reduction about 3 years ago. She has keloid tissue around both areolas and now has a severly inverted right nipple and somewhat inverted left nipple. Both nipples were leaking lots of colostrum yesterday at about 6 hours post partum, (infant was born early in the a.m. 0345) Infant is term and healthy. This sweet little one opens wider than I would have imagined he could. He isn't frustrated and gapes well over the left nipple drawing it well into his mouth. The right nipple is a whole other story. There seems to be too much scar tissue pulling this nipple inward. We have tried:
* using a nipple shield, it really just got a seal over the areolar/nipple juncture and the nipple ran and hid deep. Infant opened really wide and did draw the nipple up to the very base, still with a lot of inversion... the nipple, at its best, looked like a sombrero.
* Using the shield, and applying a pump over the shield to get the nipple out into the shield.
* manual expression to get nipple out
* reverse pressure
* using a manual pump
* using an electric pump
* finally, after trying out various sized and brands of flanges, I used an Ameda flexishield, and the Medela regular sized flange on the Symphony pump. When she pumped you could see the nipple being drawn only about 1-2 cm into the flange, but the amount of colostrum was GREAT! It was about 2-3cc.
I recommended that she nurse the infant on the left side during the night and pump the right side when possible to help bring out the nipple more and hopefully release some of the adhesions. Today the right nipple is no different, we made another attempt at using the shield to get infant access to that milk, but still unsuccessfull. Mom isn't uncomfortable when pumping or nursing. During the night the infant nursed really well, every 1 1/2 hours to 2 hours and nursed for about 10-15 minutes (on the left) each time mom states her nipple was extended (it isn't as good as it should be but it is out, and infant has an incredibly wide gape over the areola) and round after he nursed. He is still having nice wet diapers and has had several BMs
Anyone with some suggestions for this kind of inverted nipple? Manual expression on the left side only results in an inverted nipple, RPS did't work well either... the left nipple only comes out for the baby (the pump brings out the left nipple some but not like the baby). It is almost like the infant is using the keloids to help him compress the breast in the right area, and with suction is able to draw the nipple out. I know she could just breastfeed from the left, but with history of reduction, and possibility of lower milk volumes, it would be really great if she could nurse from both breasts.
I hope I gave enough information on this one, and thanks for any advise or suggestions.
Pam Price, IBCLC, RLC
Charleston, SC
USA
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