Janet Dombro writes:

<I had a client recently with what was first thought to be an abscess,
but milk was aspirated so the thought was this was a galactocele. There
were also infections signs fever , redness. The milk was cultured but I
haven't heard the results. It did refill again within 24 hours.The Dr.
implied there was infection verbally.a guess, I gather. Mom is very
engorged only a few days postpartum. Any guidelines for doing RPS in this
situation and any other ideas/solutions for easing the fullness on the
far side of the galactocele? >

My recommendation as stated in my article in JHL:
". I suggest RPS only for the purposes I have already described, during
the first several weeks or as long as needed after birth, especially when
feedings may have been skipped. I recommend caution in using RPS in
mothers with breast implants.  (I strongly caution against its use in
cases where there is any suspicion of a plugged duct or frank mastitis
symptoms, without further research evidence on soft tissue massage in the
treatment of these conditions.) "

I would not recommend RPS in this case due to the red flags for
infection. For one reason, it might disturb a possible aggregation of
infected material and spread the infection. For another, it would be
exceedingly painful for the mom. However, if the areola itself is not too
edematous, I suggest hand expression to soften the areola, trigger the
MER and keep the milk moving, by hand expression or feeding, (or very
gentle pumping if it doesn't attract edema to the areola).

As for the swelling on the far side of the galactocele, if the lobules
above it cannot drain, this will soon encourage the milk to slowly
reabsorb and those particular few lobules to involute. Since mom is only
a few days postpartum, some of this swelling may well be due to some
excess tissue fluid rather than to already formed or forming milk, even
if there is not enough to show as pitting edema. Remember that excess
tissue fluid leaves the breast in an upward and posterior direction
mostly toward the axilla and clavicle area, the opposite direction from
that of the milk. 

If the mother chooses to do so, I don't think it would cause any harm to
have her lie flat on her back for as long as she felt comfortable, to use
gravity to encourage resolution of edema. I suggest offering her the
instruction and support on how to very gently massage in an upward
direction, well beyond the galactocele area if she finds that it is not
uncomfortable and she chooses to do so. This might help encourage any
edema to move more quickly toward the natural direction of venous and
lymphatic channels. If there is pain, I would consider this a sign to
stop. 

I suggest waiting for an hour or so after the massage to apply any cold
therapy if desired for comfort, as it might tend to constrict the very
venous and lymphatic  vessels we need to drain the excess tissue fluid.

Then, there is always cabbage. I don't understand cabbage, but, then,. I
don't think it could do any real harm as a last resort. Let's ask the
cabbage queen.

Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA




. 

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html