Linda - Once or twice I have seen the "cuts" you describe, suddenly appear
at the junction of the nipple and areola as a mom starts pumping when the
suction draws the nipple into the narrow part of the flange.  Cause -
Thrush.  It seems as if the skin becomes extremely fragile and "tears" like
tissue paper.  Very alarming.  Very painful.  Can the mom manage manual
expression for a few days? I find that this is fairly easy to teach when
breasts have been lactating for some time (e g several weeks), mom can be
very impressed and relieved to see multiple strong jets, she may never need
a pump again!  I will be interested to see others' responses to Linda's
question.

Pamela Morrison IBCLC, Zimbabwe