I agree with Laurie, except I would guess that a pre-existing anatomical 
variation is responsible. It could be something like a slightly kinked duct, 
blocked and inflamed once, scarred as a result, and then worse with 
subsequent lactation. We are not absolutely symmetrical, and anatomical 
variations are common.  Another possibility is a growth.  In any case, it 
seems that that particular part of the one breast is not allowing milk to 
flow easily and tends to block, causing mastitis. It is possible that after 
recurrent episodes of mastitis, the area distal to the blockage might 
atrophy and the problem resolve permanently.  But it would not be pleasant 
to live through all that...

Weaning on one side sounds a practical response - she gets to continue 
breastfeeding, baby is given what she is entitled to, and the main drawback 
will be the imbalance of her breasts.  I would suggest that she have a 
mammogram on the affected side, maybe now and again well after weaning.

Perhaps the oversupply will make it easy for the mom to feed on one side, 
although it will be hard to dry the other up!   That would be hard in any 
case if she is weaning altogether, or even just for daytime nursing.  The 
key is to do whatever gradually.

Nan Jolly MB BCh. IBCLC. LLLL
Port Elizabeth, South Africa

> The first thing I thought of was oversupply, even before I read where you
> mentioned it in your post. The second thing is some sort of physical
> blockage, like the way she sleeps (mostly on that side???) or maybe some
> narrowing or twisting or cyst pressing on that ductal area????
> She can certainly re-lactate if she is sad about weaning and I would
> encourage her to do that. She needs a thorough consultation to determine
> what factors might be contributing to the mastitis (poor general health,
> fatigue, long intervals between feeds, restricting access to breast in any
> way, pressure on the ducts, overstimulation via pumping, etc).
> She can wean on one side only if it's always that side that gets inflamed. 
> I
> don't know how old the newest baby is, but I do find it can be difficult 
> to
> breastfeed only at night with a young baby/child. It would be possible 
> with
> a toddler, yes. But with a younger child she may have more trouble with
> engorgement or with breast refusal or with latching, all factors that can
> contribute to more bouts of mastitis.
> Laurie Wheeler, RN, MN, IBCLC
> MISSISSIPPI USA
>
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