Diane,

I offer you just a few gut level "stabs in the dark".  

Of course, it may be something unconnected to her past history. What is her current lochia situation. Is she still having bright red blood? Clots? There could always be the possiblity of retained placental fragments.

I was just reading a reference this a.m. about how the mammary gland is an evolution from sweat glands, or something to that effect. Made me wonder about whether there might be a genetic connection with her sweat-gland situation, possibly some insufficient glandular tissue?? Have you viewed her breasts without a bra? I once completely missed ISG on a mother I was seeing for something else completely, because I had never explicitly asked her to allow me to examine her breasts. When I made a home visit, she had her bra off, and I realized that the midsection of her bra had previously completely hidden the fact that she had 3-4 finger-breadths of flat area over the sternum. (She was so dedicated that she used a home-made supplemental system (a la Jack Newman) and much pumping all during the 18 months she nursed that baby. 

(As an aside, a year or so later, called me when 3 months pregnant to report she was experiencing very marked prenatal breast changes. She went on to nurse that 3rd child without supplementation for over 2 years. Makes me marvel at nature and the power of prolactin/increased prolactin binding sites from her faithful pumping;-)

Also, it might be an idea to consult an expert source about whether her surgery might have interrupted a neural pathway for the transmission of the MER stimulus to the pituitary?? I googled "Thoracic sympathectomy hyperhidrosis" and found this well-known and trusted name: 

Hyperhidrosis Treatment, Cure Excessive Sweating, Thoracic Center ... 
www.rwjuh.edu › Services › The Thoracic Center - Treatment for excessive sweating is available at The Hyperhidrosis Center at Robert Wood Johnson University Hospital, New Brunswick, NJ.

One possible way to get a clue of course would be to show her how to perform Revers Pressure Softening for 60 seconds before and once or twice at 5 minute intervals during pumping, because in my experience, it has always stimulated the MER within 1-2 minutes, even in mothers who might have had excess IV fluid in labor. (You described her labor as uncomplicated, so I am presuming she had little or no IV fluids intrapartum to cause the situation I usually suggest RPS for.)

Hoping you can find an answer to help this mom and baby.

K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC, Dayton OH USA

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