I have a client who delivered twins at term almost 5 weeks ago. The female baby had a cord trauma prior to delivery and died at one week of age. The male baby has done very well, and been exclusively breastfeeding since the end of the first week. (Mom spent so much time going back and forth from the NICU to see baby girl that she had to supplement during the first few days) I saw mom last Thursday at a breastfeeding moms/babies support group and mom had symptoms of yeast on her nipple and what looks like a plugged Montgomery gland with a cyst underneath about 2 mm from the base of the nipple, in the upper/outer quadrant of the areola on the right breast. I also thought that it looked like the gland was not only plugged but also, irritated as was mom's nipple (that I thought appeared to be yeast). The baby's mouth just barely touches the area but it is very tender for mom.   (Baby has no symptoms of thrush and no diaper rash, I do always recommend treatment of mom and baby but it is always up to the mom and the pediatrician, in this case the pediatrician did not feel infant should be treated unless symptoms develop, mom is giving infant acidopholous)

 I recommended mom contact her OB doctor for evaluation of the plugged gland and cyst-like area beneath, and gave her information for treatment of the yeast, plugged ducts and cysts.  I suggested she start following our sore nipple treatment care plan, which includes gently washing the affected area each day, treating the wound or area with an ointment,  and warm compressess to the area prior to feedings. Mom began using our over the counter version of Dr. Jack Newman's APNO... which by the way is extremely similar to Dr. Hale's APCNO... all purpose cheap nipple ointment (Clortimazole, Bacitracin, 1%hydrocortisone) which he talked about at the ILCA conference this year.   Mom said that there has been great improvement of the tender nipple pain, (yeast) since she began following the yeast treatment plan, and using the APCNO, even the plugged gland has gotten less irritated but is still very tender and the size of the cyst is the same.  She also feels like other Motgomery glands on this same breast are looking more raised and full, and she is worried they will develope cysts under them as well. She finally went to her OB yesterday for an exam. The OB felt that it really isn't a problem (good for her!) and there was no reason to do anything. I had thought that the doctor might want to biopsy it since it feels like a cyst under the gland and the gland is enlarged, that or drain the cyst, and the mom asked the doctor about that but the doctor said that there was no reason to do anything like that because it would increase the risk of a bacterial infection. Mom has reviewed all of the information we give on plugged ducts as well and is asking if ultrasound would be a treatment option for this since she really wants some relief.  She was not really pleased with the doctor's advise, mom wants some relief of the pressure and discomfort and was hoping the doctor would drain it or do something.  If it is just a plugged gland would ultrasound break that up and allow it to drain? and even if it is a cyst, would the ultrasound help to open entry area and drain the cyst?  

Thanks for anything... 

Pam Price IBCLC, RLC
Charleston, SC USA

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