Anne, you said >Her nipples looked bulgy and soft, not firm, and they were always tender when she nursed. I made the diagnosis based on exclusion of all other possibilities. I've seen very sore bulgy soft odematous areolar tissue as a result of pumping at excessive pressures without an appropriately-sized adapter: the whole of the areolar tissue was being grasped and dragged into the pump attachment; the nipple hardly extended at all, but rather the whole breast did. Was this mother pumping for her twins? In the case I saw, areolar tissue was so painful the mother couldn't touch it, no other cause whatever. Subsided slowly over time: cold, anti-inflammatories and cabbage might have helped if I'd known enough to suggest it, but I didn't at the time. Maureen