Brenda,

You wrote:

< She claims to be
having pretty intense  pain on the sides of her breasts and in her
nipples.
She says that sometimes the pain is so bad that it feels like a needle is
going through her nipples.
<  I thought this might be related to skin stretchening, but
would like to know if any of you other LCs have heard of this complaint
prenatally before, and if you have another suggestion for what the
problem
might be.>

Nipples and breast pain have occupied a lot of my thinking over the
years. Let me take a guess.

It sounds to me as if your assessment is at least partially right.
However, rather than skin stretching alone, it seems to me that the
pathway of the pain she describes points to a duct, perhaps associated
with scar tissue impinging on a nerve at some point.

If I am reading your post correctly, this is bilateral. I would be
interested in knowing her cup size. I would think a somewhat pendulous (C
or above) breast might tug more if there were scar tissue being disturbed
by the stretching attending the growth of new glandular tissue.

I have come across several references mentioning a condition called duct
ectasia which involves tissue changes that can be caused by injury or
infection. I would think injury might be more apt to be unilateral, but
this is only supposition on my part.

I am imagining that if there were scarring involving traction on the
longitudinal myoepithelial cells that surround a duct wall, occasional
MER's experienced during pregnancy might cause some pain along the path
of that duct. Have her cover her nipples with a thick sleep bra or 2 tee
shirts etc. at bedtime to lessen the chance that MER might be stimulated
by friction from bedclothes when she turns over.

Suggest that she expose her breasts for 5 minutes or more of warm water
with massage at bath time, preferably upward and inward toward the axilla
and chest wall, perhaps with the same technique as a standard monthly
breast exam. I think this assists in the clearance of lymph from the
breast tissues which might be slowed somewhat by gravity in pendulous
breasts.

I believe she could gain reassurance about the actual breastfeeding
experience by testing this suggestion for the nipple area itself at
times other than the bath. Suggest that she fold  a clean washcloth in
quarters, and saturate it with  the hottest water she can stand on the
inside of her wrist, to make sure she doesn't burn herself. Hold it over
the nipple and areola for 3 minutes. This seems to elevate the pain
threshhold. I have found it especially comforting for undamaged but
painful nipples in the first days of nursing when the baby is learning to
latch, but I bet it would bring relief even now.

I am curious to see what others might suggest and how this workd with
this mother.

K. Jean Cotterman RNC IBCLC
Dayton, Ohio USA

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