There were no replies on Lactnet to my post about the mother with a puffy
outer areola after feeding. I wrote to Jean Cotterman privately and she
sent this reply to my question. It is so informative that I want to share
it with all of you.

To summarize, I see that the areola didn't grow puffy *after* feeding but
was already edemic. When baby fed, the area where her mouth was, lost its
edema, hence the puffy look outside that area.

Pat Gima, IBCLC
Milwaukee, Wisconsin

At one week, my first question is how many bags of IV fluid did she have,
if any? It takes the body 2-5 days to get rid of each 1000 cc.
administered, especially if there was a fair amount of pitocin involved
either inducing, augmenting labor or keeping the uterus firm postpartum.
How are her ankles?

Fluids like ringer's lactate (i.e. what are called  crystalloid fluids)
change the chemistry of how the arterial capillaries release fluid,
dissolved nutrients, etc. to become interstitial fluid, and allows excess
interstitial fluid to fill the tissues beyond their normal. Can create
edema, even pulmonary edema, in severe cases. Normally, even without IV's
or pitocin, interstitial fluid ("the lake that bathes the cells") takes a
while to "percolate" the nutrients to the cell walls, exchange for the
waste products, and then seep back into lymphatic and venous capillaries.

Excess interstitial fluid does not become frankly visible edema till it
is 30% more than normal for that tissue, and from 30-50% it will pit.

It may be that the number or quality of lymph capillaries in that areola
differ somewhat from the other, either developmentally or from scar
tissue. Perhaps the fibrocystic condition might figure in here slightly
somehow, but I am only guessing.

Did she ever have any injuries to the chest as a child or teen? One that
she may have to search to remember? (Like the one I got at 11 while
riding a bike without handlebar grips, when I looked where I wasn't going
and ran into someone's back bumper. Had a raw half moon of a scar there
for months, but I was in denial that it was important enough to confess
to mom! It eventually healed on its own, but I use that as an example.)

As long as it's not causing any problem with milk transfer or comfortable
nipple elongation, it might be best just to observe it, and ask her to
report on its progress, as a learning exercise if IV fluids were in the
picture, and see if it doesn't clear by itself by the time the baby is 14
days.

However, it wouldn't harm a thing if you want to teach her RPS, starting
near the nipple, and then another round just beyond that, and then
another further out if needed. Would just give what is known as the
lymphatic pump a little assist.

Those are the immediate things that pop into my head. Feel free to share
with LN if you think it helpful to anyone. I'm giving up my addiction for
a short while to focus on a project.

Keep me posted on what you observe, etc.

Jean
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