I don't have a lot to add to Jean Cotterman's insightful post about the hole at the base of the nipple that won't heal, but thought I'd chime in in agreement that there may be a fistula into a sinus or duct. It might be more difficult for such a breach into a duct to heal than just penetration into nipple/areolar tissue. I wonder if she could visit a plastic surgeon and just have the wound visualized. He/she could give an opinion if a small stitch or two could close the wall. Right now the lobes 'up river' are draining thru that hole, and one has to hope the closing of the wall of the wound could be done in a way that didn't seal off, but would re-canalize the main pathway. If they can rebuild perforated nasal sinuses (which is done all the time) then I don't know why this couldn't be surgically achieved with micro surgical proceedures. Maybe a really good breast surgeon would be another option. I have a lot of experience watching quite severe nipple fissures heal. I've seen nipple rings removed, large cracks from sucking trauma, etc, and the tissue typically granulates well and heals up over time even with milk draining out. Sometimes a superficial sort of infection prevents the tissue from knitting. So one thing that might be wise to try is to coat the fissure with Bactroban (mupirocin), and to rinse off after nursing so the surface is kept clean. The mother may also want to consider a partial, unilateral wean-down to slow production on the affected breast. I've got some new photos of a punch biopsy of a nipple to rule out Paget's disease where the dermatologist took out a 3 mm core of tissue from the nipple face to examine. He put a stitch in it, which I was pretty sure would be more annoying than useful. Within 2 days the mom persuaded him to take it out because pumping wouldn't drain the breast and the 7 mo old baby could. The sutures bothered the baby. The nipple is granulating in slowly. I don't think a suture at the base of the nipple would be as intrusive, and you could cut the tip off a nipple shield and use the silicone ring to cover the wound. Barbara Wilson-Clay BSEd, IBCLC Austin Lactation Associates http://www.lactnews.com *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html