Hi all,

Well I'm at my wits end and could use some suggestion.

I have this pt that has an abnormal shaped nipple, not completely round,
looks like it had a slit made through the middle to the middle of the nipple
and then dimpled in the middle.  This pt did not deliver with me so not for
sure what the nipple looked like before delivery.  I saw the pt 1 week post
delivery for the first time.  At that time she had a thriving baby, but a
horrible damaged nipple, with unbearable pain and had a possible abscess
already.  I sent her to an OB for treatment of ? mastitis/abscess( she was
given antibiotics), rented her a pump and gave her the option of nursing and
pumping on that breast or just pumping till the nipple had improved.   After
a few days the nipple had healed some and the lump/ harden area had
disappeared.  She started the infant back nursing and within a couples of
day call with a high fever, red breast and nipple trauma. Again got her on
meds and stopped nursing on the traumatized nipple, only pumping.  The next
morning she called again even more ill than the night before.  I called the
OB who referred her to a surgeon after seeing her.  The surgeon is one of
her husband's partners.  They did an ultrasound and found 4 abscesses.
Opened up the abscesses, drained them and packed them and place her on high
doses of antibiotics IV and oral.  She went to only pumping both breast
related to too much pain even holding baby.  After about a week of meds and
abscesses draining things were doing better, but she was still only pumping
on the affected side.  While still on meds and not nursing the affected
side, she developed another abscess in a different location on the same
breast.  The abscess had to be it drained and placed on now another
antibiotic  

 From the very beginning I had wonder if because the nipple anatomy was
abnormal could there be areas of the breast not draining, no outlets, and
causing all the problems.  What I have finally done is wean mom off the
affected breast with the approval of all the other care providers, surgeons
included and have her just nurse the normal nipple and breast.  I had her do
all the normal things with mastitis: hot, cold, rest, meds, and nutrition.  

Where did I go wrong, what should I have seen or done differently? 

Any thoughts would be welcomed.

 

Crystal Stearns RNC, MS, IBCLC

Mercy Memorial Health Center

Ardmore, OK 73401

 


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