Hi everyone,
Thanks for all the advice and help. I spoke with the mom today for more
info.  She had tubular breasts without many changes at puberty.  When she
was 20, she went in for implants and pre-op (after IV started etc.) her
surgeon said he couldn't do the implants without some reconstruction surgery
as they wouldn't look much different.  So he told her he would fix them at
no extra cost.  She said he never mentioned a possibility of not being able
to breastfeed in future---in fact, nursing was never mentioned.  She does
have scars around the entire nipple/areola and thought the nipple had been
removed.  However, during pregnancy her breasts definitely got larger and
more tender, nipples darker and firmer.  She had leaking colostrum from 7th
month on.  She has a great pump (Purely Yours) and has used the Elite as
well.  I have observed baby at breast and mother has leaking from other but
doesn't feel a strong let-down.  Her baby was 7 lbs. at birth and is 9lb 2oz
at 4 weeks.  She has given no more than  2 (4oz) bottles of formula when
needed in a 24 hr. period if baby is still fussy.  Baby is having adequate
stooling and wet diapers.  When she takes a break from nursing and only
pumps she says it's much better though it still "burns" while pumping just
not as intense. She has to start at a very low setting and can only stand
the pump at half suction. She states that she has had hyper-sensitive
nipples since surgery.  I still think she has yeast and have given her Dr.
Jack's handout on gentian violet which she will try.  Her Dr. said there is
no way it's yeast but she describes burning and shooting pain worse at night
and worse during the feedings.  Her nipples appear "pinker" to her but you
know the drill-the uninformed providers won't treat for yeast unless they
see it on her or baby...uggh!  Oh, on her formula supplement, she has been
using Similac low iron and the pediatrician had a fit because she said she
definitely needs the iron.  Trhe mom told her that her LC said she was
getting enough iron from the breastmilk but the ped said no way!  It  is SO
frustrating.  This mom will contact her surgeon to find out about her
surgery. I think she may have some scar tissue but she pumps 2 oz. per side.
Should she continue the fenugreek?  She will do some cluster pumping as some
of you advised.  I really appreciate all of your help on this one.  I'll
keep you informed.  I'd love any other suggestions.
 TIA,  Kym Dunton, RN, IBCLC, Amelia Island, FL. USA

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