There is a picture of a woman (Fig. 110) in The Breastfeeding Atlas, who had
long nipples that were shortened (sliced like a loaf of bread) by her
surgeon while he was inserting breast implants.  Because the insertion was
at the periareolar edge, she had impaired lactation and an infant (Baby #2)
who failed to thrive.  Baby # 1 breastfed normally prior to the surgical
procedures.  The nipple shortening created exquisite tenderness in one
nipple -- too tender to tolerate direct nursing.  The other nipple was
practically numb.  She was unable to feel what baby was doing on that side,
and poor latch created nasty nipple lesion (shown in picture in the Atlas).

Long nipples can create nursing problems in an of themselves.  Babies tend
to perch out on the nipple shaft doing a lot of non-nutritive feeding.  It
is important to evaluate the baby's "reach" and make sure (with positioning
tricks) that the jaw closure is over the lactiferous sinuses.  Postfeed
pumping and use of pumped residual milk as supplement can protect baby's
growth and mom's supply until baby gets bigger and is a better "fit" with
the nipples.  Perhaps this is a situation where some breast compression over
the areola might assist.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.lactnews.com

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