Thank you, Barbara, for your reply.
I agree about the red flags for milk production and will discuss these with
the mom.  Aware that the success of early milk production has an effect on a
good supply in the long term, and given that this mom will be separated from
her baby 6 hours a day/5 days a week and pumping, I know that this is
important information for her.
This mom sounds like a can-do individual who prides herself on handling
tough situations--not just her experiences with birth and breastfeeding, but
also her work.  However, neither mom nor doc readliy recognized hers as a
slow-gaining baby!  And I am astounded that this mom didn't get the lump
more thoroughly checked out during the 20 years she had it!
Please help me understand the relationship between the injury and the
mastitis, whether during pregnancy or breastfeeding.
Could breast changes during pregnancy have caused the flare-up of a
(possible) cyst (resulting from the old old injury) that had previously
reduced to a small, undetectable-by-feel level?
The lump is under her arm, down from the pit and where the breast joins the
chest wall.  What would this location suggest about the impact on the
drainage pattern of the breast?
Would long-term maintenance antibiotics, once the initial infection is
resolved, be one strategy to help her manage the mastitis?
You suggested a consult from a IBCLC.  There are no local ones--the closest
is about an hour and a half away--but I will suggest that mom pursue this.
Again, thanks for taking the time to help.
Diane, LLL
Florence, VT

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