Look for a tongue tie, baby might be chewing the breast and bruising the 
areola while compressing the nipple, as a compensation for reduced 
tongue mobility. Also, scar tissue is less elastic than breast tissue, 
and some mothers who have had reductions have more pain from stretching. 
A breast pump with a soft, conforming flange (Whittlestone, playtex 
embrace, Dr. Browns hand pump which was designed by Whittlestone) might 
make pumping more tolerable for her. These pumps tend to be less 
efficient than the hospital grade ones, so she will likely need to pump 
for twice as long. If that's not going to be an issue, then these pumps 
that pull less might help. Ameda also makes a silicone flange insert 
called a flexishield which fits in their hospital grade pumps, and might 
help if it does not make the nipple tunnel too narrow for her comfort.

Catherine Watson Genna, IBCLC  NYC

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