Need help with this one:  Pt had a child 2 1/2 yrs ago, probable
hyperlactation, bf 18 months.  Pt had lump in her lactating at 8 mo pp.
  Dr performed lumpectomy, pronounced it "benign."  Mom continued to bf
for 10 more months, got pregnant, weaned. Old incision site at upper
outer quadrant is noticeably depressed.

Pt delivered a baby girl 2 d ago.  Several hours ago she noticed
swelling above the old scar from the incision site--I have just gotten
the call so haven't yet gotten over there to see it, but she describes
the swelling as dramatic, as being "visible across the room."  No
fever.  No exquisite tenderness.

My thoughts:  use ice but no heat, no pressure, and allow body to
resorb milk and allow body to involute in the affected areas, assuming
there are "blind alleys" from the surgery or a galactocele which may
have existed prior to the original surgery or may have been created
since then.  Continue to breastfeed bilaterally.  If the ducts are
truly blocked (as I am guessing), the chances are she will not have
infectious mastitis or an abscess.  Monitor closely for other sx such
as fever (realizing that a low-grade rise in temperature may indicate
inflammation but not infection).

Would you advise differently? Would you advise her to proceed
immediately to Dr. for possible needle aspiration or surgery?  If so,
what would be the rationale?  Would you wait?  If so, for other sx or
for a certain period of time?  If it were an abscess, she would be
unlikely to have a warning such as a high fever, and could possibly be
at risk for septicemia if the abscess were to rupture, plus the
destruction of breast tissue that an abscess would involve.  However,
the abscesses I have seen involved a color change, which she denies
having.  Also, there were not any sx of mastitis prior to this.  Has
anyone had a similar case?  If so, what was done and what was the
outcome?

I am going over to see the breast now.  I look forward to any thoughts
any Lactnetters may have.

Arly Helm, MS, IBCLC

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