Hi Amy,
I've had a similar experience myself, twice now, after ending up with a scarred left side after misadventures trying to nurse my first son.

My 2nd son was a 34-weeker who had a 3-wk-long NICU stay, and I never quite developed a full supply on my nursing side.  He needed to be supplemented a good amount, so I continued pumping on my injured left side in order to feed him that in addition to what he could get from nursing directly.  I tried and tried to nurse him on my left, but it was intensely painful and he always compressed/mashed the nipple -- pumping was tolerable so I continued that.  I started taking domperidone at maybe around 6 or 7 months in an effort to increase my right side's production so that I could wean the left, and that actually worked nicely, and I weaned very gradually so that the left side was totally "dried up" by around 10 -11 months.  I went slowly with it since I was back at work and needed high pump volumes since he really overfed by bottle in my absence.  He's still occasionally nursing now at age 4.

My current little nursling is 8 months old, and I only ever tried nursing him on my "injured" side a few times before giving up because of the pain.  I didn't trust him to bring in a full supply on my right since his older brother couldn't, but he gained beautifully without any supplementation.  I continued to pump about 10-12oz a day on the left side just in case he ended up needing it, but decided to wean that side completely by about 2 months since I was sick of pumping, had a freezer full saved up, and frankly knew that I responded well to using domperidone and could always start it if I need to.  So unilateral nursing has worked really well this time around for us.

For the mom in question, I would be pretty cautious about trying to completely wean one side and just rely on a 33-wk-old to maintain a good supply (especially if mom has 2 other little ones at home to care for).  That is my bias, though, as my pre-term son and I couldn't pull it off. ;)  If she is able to tolerate it, I would suggest pumping that injured side gently, just to try to get a buffer of extra milk built up in case her baby ends up needing it.  My own supply seems quite tenuous at this point and has decreased considerably in the past couple months, so having built up a huge freezer stash early on has been a really nice reassurance even if we're not really using it.

Good luck to this mom,
Sarah Reece-Stremtan M.D. (peds anesthesiologist)

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