I would definitely recommend culture the nipple area that is a problem area,
even if small. She could also have the milk cultured, a clean catch
specimen.
I am thinking she has maybe a blocked duct behind a nipple pore that is
occluded or infected and possibly an abscess is in there.
 I think an ultrasound is definitely in order.
She could possibly have inflammatory breast cancer, as one possibility not
to be taken lightly for repeated bouts of mastitis.
Have you or another LC seen her and her breast in person.?
Laurie Wheeler RN MN IBCLC
Mississippi USA

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