I cannot remember who originally posted on this, but the description was
of a fissure evident right after the initial feeding. Darrilyn posted her
experience. I have another possible explanation.

I used to do a lot of closeup photography of nipples and nipple function,
much of it done prenatally. The developmental differences between nipples
continues to fascinate me. I have a set of slides I used one time during
a talk to a large audience to illustrate how looks can be misleading. The
nipples, at 34 weeks, both look perfectly normal, with a relatively short
shank. (They appear to be the kind that would begin to look flat in a
hurry postpartum if a woman had had enough IV fluids to overhydrate her
body, even before engorgement came on.)

The next picture shows what appears to be an awful fissure in the center
of the nipple, and of course the audience gasped. (The geometirical look
of the open area reminded me of the childhood game of "cooties" played
with an intricately folded piece of paper opened and closed with the
thumb and 3 fingers inside the folded paper.)

But it was merely what happened on compression of the sinuses (or
spreading of the nipple by pressure close to the base, I don't remember
which), revealing a "4-petal" looking separation of the tip of the
nipple, revealing a 1/8" deep pitting in the center, lined with
pinkish-red epithelium (like the inside of our mouths or eyes) and at the
center was the location where all the galactophores emptied out in a
single space, rather than individually on the surface, where they do on
most nipples. This anatomical variation occurred with both nipples.

This has been so long ago I don't remember the specific teaching I gave
the mom, but I did call it to her attention that this was her normal
anatomical characteristic, and that she should be aware of it in order to
alert the hospital staff that it was not a fissure from damage. I may
have told her to make sure she kept it open to air, to dry after feedings
to lower her risk of thrush, somewhat like Chele Marmet advises for
dimpled nipples. In retrospect, I wonder if that pink epithelium might
not have become "epitheliulized" if constantly exposed to air the last 3+
weeks of pregnancy, perhaps by the use of shells???( much like the glans
of a circumcised penis eventually does)

Of course, the nipple would still have been at risk for all the other
kinds of damage brought on by poor latch, etc., but at least the normal
appearance of the pit receiving the galactophores would not have elicited
a reaction of "instant fissure" because of my forewarning of the
developmental individuality.

I have observed that the appearance of skin damage elicits an automatic
assumption that the damage is the source of all nipple-areolar pain. For
those of you still waiting on my promised illustrations and article on
"Zone Model for Assessment of Nipple Pain", I haven't forgotten you. Your
requests are in my inbox, waiting. "Life" has just gotten in the way of
keeping the promise (death of a good friend, needing new furnace after
old one konked out for good in single digit weather, etc.) I'm also open
to requests from anyone else interested in the article and illustration.

Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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