Hello Wise Ones,

I have permission from my client to post.

Mom presented with nipple cracks and severe pain during latch and throughout feed.  Baby is now 3 weeks old, I have been working with them since baby was 1 week old.  Baby had posterior tongue tie, and lip tie, both clipped at 2 weeks of age (1 week ago.)  We have worked on technique, gotten a deeper latch, though it is still could be a bit deeper.  Instead of throughout the feed, pain is now limited to latch-on, and is a 8/10 instead of 10/10.  Cracks slightly improved in the days following frenectomy, but now seem to have stagnated in their healing.  (I know more time is needed to give them a chance.)  Mom has been using APNO since birth.

Baby will be seen by an osteopath tomorrow, though there are not yet any glaring signs of muscle tension that I can see.  The puzzle is that mom's cracks began in late pregnancy, before breastfeeding ever started.  About 10 years ago, mom had an injury (piece of wood puntured L breast) that required surgical repair.  Mom was not happy with the appearance of the repair, so she consulted with another surgeon who did further surgery.  In the process, mom realized that the breast that was injured (L) had never filled out the same as the other side and was quite flat.  So, she decided to have augmentation at the same time as the second repair.  Implants were placed in both breasts.  It was deemed necessary in the R, uninjured breast in order to even out and match the size of the L side.  She has peri-areolar incisions, as well as an incision under each breast.  Nipples were repositioned.

Miraculously, she has lots of milk so far, and a MER that is functioning beautifully.  But, she has massive pain due to the cracks that began in pregnancy.  What would cause cracks to begin during pregnancy?  I suspect it has something to due with the surgery (excess tension on the skin, maybe blood and other circulation in the skin is disrupted, therefore skin integrety is affected, or ???)  Could cracks during pregnancy be caused by anything else?

I have referred this client to our local tertiary care breastfeeding clinic because I am stumped.  But it will take a few weeks before she is seen.

What else can I do for this poor mum?

Jennifer Welch, IBCLC, LLLCL
Montreal, Canada

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