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Wed, 15 Jun 2005 22:20:16 -0500 |
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I am reluctant to try and comment over email...but will try.
I cannot come to terms with a physiologic reason why skin would "grow over"
the nipple pore. I agree that an "old", recurrent bleb can start to look
like that, but I can't believe that is the initial mechanism that gets it
all started.
I can't remember where I heard the theory, but what makes the most sense to
me based on what I see is that the duct wall gets damaged (from poor latch
or excessive pump suction) and the milk actually dissects (or burrows) out
into the tissue surrounding the duct and then can't get out. The mom
describes excruciating pain, which seems way out of proportion to what you
see. I attribute this to stretching of the duct walls near the opening,
which stretches the sensory nerves, much like a very full bladder feels. It
makes sense to me that the wall of the duct would try and "heal" after
lancing with the needle, requiring repeat lancing. Often these ductal pores
never look the same again...often they appear much wider, or "dilated".
It is harder to explain the ones where the plugged duct seems to come before
the bleb...
I wish someone would biopsy these and tell us what is REALLY going on!!
Kathy Leeper, MD, IBCLC
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