I am a doctor, who together with a very experienced lactation consultant, is involved in the care of a first time mother who is very keen to breast feed.  She has bilateral true inverted nipples and has been manually expressing since day 3 post partum (initially 0.3mL colostrum).  She is now 3 weeks post partum and has "full milk production" by manually expressing approx 100mL every 3-4 hours day and night, which is very labour intensive.  The Medela breast pump (funnel type breast shield) with stimulation then let down cycle is ineffective, giving only 10mL breast milk at best.  Baby was full term and is normal and is bottle feeding the breast milk vigorously.  We are not concerned about his ability to latch.  We have tried him directly to the breasts, and via nipple shield, but are unable to generate any let down.  We are concerned that the degree of nipple inversion may be associated with some underlying duct issue/that the ducts are further
 back than anticipated.  Does anyone have any other suggestions?


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