(Permission from Client granted)

I have a client, approx 7 days pp with her third child, all brestfed. She
has experienced painful engorgement with all three children, with each
becoming more severe and painful. She had a bad bout with mastitis with the
second baby. (I have personally been seeing this woman as her LC since the
first baby was born a little less than four years ago.)

I saw her a 5 days ago and, she was tearful from the pain and I set her up
with a week pump rental with directions to nurse frequently, use cold packs
and cabbage. and *only* to use the pump if the pain was terrible, or the
breast was so disended the nipple was unable to be formed.

She said she had some "weird lumps" under her arm and showed me what I have
seen before, golfball size swellings on the front part of the armpit. I
explained that it might well be either backed up lymph tissue (her bra was
too small!) or an "extra" breast. I explained that a lot of women even have
a mole, which is a vestigal nipple. Her eyes widened and she showed me the
other armpit, which contained such a mole. She also had the swelling on
that side, but it was not as severe as the other. The 'nipple' was about 2
inches from the swelling, closer to the arm than the body.

She called yesterday and said the breast engorgment was totally gone, she
had only had to use the pump twice, and the baby was nursing every 1.5 to 2
hours round the clock and "growing like crazy"(YAY!!!!) I think she has
finally caught on that early treatment, and very frequent feedings are the
key, here, for engorgement.

But she still had the swellings under her arms and she said it was scaring
her.

These swellings did not present during pregnancy, by her report, and
although she thought they may have been there, in a smaller size with her
second baby, they weren't this large or persistant. She said the they
presented when she became engorged, less than a day after the baby was born.

She has stopped wearing her bra, and I strongly suggested more cold packs
and cabbage for the swellings, and to see her MD if they didn't go away in
a week or so.

My question, about how long will these swellings take to go down? I am not
even sure if they are tail of Spence or Auxillary Breast tissue. They seem
to resemble both. The appearance of the aux nipple leads me to think breast
tissue, the placement (at the front of the armpit) makes me think Tail of
Spence.

If anyone knows how long we need to wait before becoming concerned and
contacting the MD, it would be helpful.

TIA,

Mary Jozwiak IBCLC, RLC, LLLL, AAPL
Private Practice

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