Hello,
     As regards the mother with persistent breast pain and a history of
surgery for tubular breasts:
I thoroughly agree with Laurie Wheeler's rec. that the mother's surgical
notes be investigated.  If the mother did have tubular breasts, it may be
that more work was done at the chest wall to broaden the base of the breasts
so that they could look cosmetically acceptable with implants.  (If the
breast base is too narrow, adding an implant is not going to look good.)
Only by finding out what the surgeon actually did will some potentially
important information be known.
   For information on categories of tubular breasts, you might like to
access an excellent article by Kathleen Huggins and colleagues, which was
earlier presented as a paper at the July 1999 ILCA Conference in Scottsdale.
It is a good place to start for good information on tubular breasts and
lactation.  [The reference is:  Huggins KE, Petok ES, Mireles O. Markers of
lactation insufficiency: a study of 34 mothers. Current Issues in Clinical
Lactation 2000: 25-35.]
   I would also urge the lactnetter who raised the issue of her client to
monitor carefully the baby's growth.  Low supply might - just might - be a
factor in the pain, though I suspect the situation is multi-factorial.
Supplemental tube device, as already suggested, if supply needs a bit of
help.
   It mightn't hurt to check out the possibility of a bacterial (staph)
infection. [See: Livingstone V, Stringer LJ. The treatment of staphyloccus
aureus infected sore nipples: a randomized comparative study. JHL 1999
(Sept); 15(3): 241-246.]
   It would also be good to read the useful and timely Clinical Perspective
in the December 1999 JHL. [Heinig MJ, et al. Mammary candidosis in lactating
women. JHL 1999; 15(4): 281-288.]
    This mother is fortunate in having the support of someone so caring and
supportive, and willing to seek out information.
              Cheers,
                     Virginia
                      Virginia Thorley
                       in Brisbane, Queensland

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