Brenda writes:

<I will soon be working with a mom who had surgery to reverse inverted
nipples.  I believe the name of the surgery was inverted nipple tissue
release.  Couldn't find anything after an archives search.  Anyone had
experience with this?>

Nipple inversion is an area of special interest for me, and I have done extensive reading on the subject. The plastic surgery literature is full of  descriptions of various types and degrees of inversion in the first place, and literally dozens of suggested approaches to such surgery. It might be very interesting and helpful if she could request the doctor's initial p.e. report of the breasts and nipples and the op report from her surgery from the doctor or the hospital.

I remember reading some titles that include "with preservation of lactiferous sinuses" or some such phrase in the title. Whether or not the nerve connections to the nipple were completely interrupted might also have an effect on MER if the surgery were bilateral. (Just earlier today, though, I posted on the fact that massage effecting the myoepithelial cells surronding the ducts, as well as neuro-hormonal factors can stimulate the MER.)

I would venture to suggest that under your close observation and guidance, she has a good chance of a rewarding experience, even if exclusive breastfeeding proved not to be a possibility in the long run. I would suggest preparing her prenatally with a thorough view of nature's plan for breastfeeding, focusing on the whole process rather than just on the nipple.

Emphasize especially the fact that she is the only mother her baby will ever have known, and she has a right to insist on no rubber nipples, in order that her nipples be the only nipples her baby will have ever known. Remember to emphasize the importance of softening the areola before latching during the first 7-14 days, since some of her lymphatic pathways in the areola might have been interrupted.

Help her know what to ask for, so she can follow ideal breastfeeding guidelines (birth with no, or the least possible interventions, early, prolonged skin to skin and nursing, etc. etc.) and refusing the use of any common interventions such as a shield, supplementer, fingerfeeding, etc. unless you, personally, have a part in deciding whether they are necessary.

I also suggest referring her to Diana West's book "Defining your own success: Breastfeeding after breast reduction". This would expand her ideas because I believe that some mothers have even had breast reductions by procedures that involved complete removal and reattachment of the nipples, and I have seen recanalizaton mentioned in other publications describing breast surgeries.

Jean
*************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA (where they cancelled choir practice last night because of inclement winter weather, while I have access to Arizona's sunny weather for another week!)

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