Margery writes that she has spoken by phone to a mother who is in early lactation who had reduction surgery sev. yrs ago. This mom is experiencing intense pain along suture lines. I have several comments about the situation. First, the use of a phone consult in such situations is fraught with danger. This mother must be seen to be properly assessed. I'm sure the visual impression would reveal things not apparant over the phone. Perhaps the surgeon was more sanguine about preservation of function than is the true case. The pain along suture lines could be related to severed ducts in these areas which in early lactation would contribute to severe engorgement and inflammation in the severed lobes. These areas will continue to hurt until those areas shut down, atrophy and involute under the pressure of all that unremoved milk. If mother is taking lots of ibuprofen for pain, she may be masking febrile sx. Has she seen an MD to rule out mastitis? Pumping with a Mini-electric has not proven esp. useful for mothers I have worked with who have pathologic engorgement. They need to be using a hospt. grade pump. I would try cooling off the breasts to see if reducing swelling would unblock things and she could pump more effectively. I agree with Mary Broadfoot, and all those who have posted about the inflammatory nature of mastitis. I use cold almost exclusively. (A LITTLE ibuprofen might help with the inflammatory sx.) She also has a cracked nipple. It would be useful to visualize the wound. If its a positional stripe, one might deduce that poor positioning had contributed to the engorgement by virtue of poor drainage. You might in that case have a bad situation totally or partially attributable to poor management and coincidental to the surgery. You might also have some severed ducts, some effects from the surgery AND poor management. If the wound looks like a sort of star-burst in the center of the nipple, that may be a sign that baby is sucking very very hard to try to get milk out of a breast that is really not connected up any more -- or at least not totally connected. Its so hard to tell with these post-surgical situations, but I agree w/ Maryann Niefert's research which indicates a three-fold increase in risk for lactation difficulty if mom has had any kind of previous breast surgery. You need to visualize the locations of incisions and everything else to get an idea of how to proceed. I had one mother post-mastectomy who had phantom pain in the area of the missing breast (or rather perception of pain in her brain from the severed nerves in her missing breast.) Perhaps this phenomenon might occur if nerves have been severed even tho the breast is still there? I'd be interested to hear if people think the scars would ache. I have seen moms post-abscess surgery with scars which ached. Barbara Wilson-Clay, BSE, IBCLC priv. pract. Austin, Tx owner LACTNEWS On-Line: http://moontower.com/bwc/lactnews.html