"Most of her engorgement complaints were about the right breast (also the 
side with the chest tube.)  She was reluctant ot offer that breast becuaese 
of the pain she had "inside."  On the phone consult she had told me it felt 
like a steel cable and I asked her to gently massage it - she said that that 
action caused it to burn."

Ductal yeast is not the first thing I would think of in this scenario.  My 
first thought would be nerve irritation from the lung injury and the chest 
tube and the engorgement.  From what you present, I think I'd be suggesting 
that if pumping is less painful than nursing, just pump the right breast for 
now, and get the right breast (at least) wrapped in cabbage until the 
engorgement is under control.  How soon is she likely to get the chest tube 
out?  I'd want to see how the breast feels once those two factors have 
changed.  If it was ductal yeast, the whole breast should have "shooting, 
burning" pain, not just one spot.

Becky Krumwiede, RN, IBCLC
Appleton, Wisconsin

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