Edith Kernerman hypothesizes that some breast and nipple pain is 
referred pain from the chest wall. Stretching exercises and breast 
massage before and after feeding can be helpful in increasing 
circulation and reducing any pressure on nerves that might make bf 
uncomfortable. Her massage and exercises have helped a mom in my 
practice with chronic breast pain who was having an exacerbation with 
bf. Look up Mammary Constriction Syndrome.

Also, I never discount reviewing and optimizing positioning and latch. 
Trying to get rid of the nipple shield might help too. Sometimes nipple 
shields give the baby a platform to bite onto, which can certainly annoy 
the breast and nipple.  Now that the nipple has everted, perhaps you can 
help her latch on that side without the shield.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com

On 10/20/2013 3:25 PM, Amberly Renfroe wrote:
> With permission from the mother, I am writing in hopes that someone can help figure this out.
> Please let me know if I am missing any information.  This is my first time.  I appreciate any advice in terms of etiquette and dyad details.  I am a newly accredited LLLL and have recently volunteered to be on a week long call list for the Denver Metro area.  One call surprised me because the mother has already seen 3 OBGYNs, 1 acupuncturist, 1 midwife, and 1 lactation consultant, and to no avail. Her mother- in- law suggested calling LLL.
>
> First time mother, 7.5 month old baby, mother has had unbearable pain for the last 2 months on right side only.  Baby will pop on and off. Right side had an inverted nipple. Baby nurses 2xs as long on right (painful) side than left. She was using a nipple shield. Since birth, the breastfeeding has caused the inverted nipple to no longer be inverted anymore.  It does look clamped, blanched, and has a white line on the side after nursing.  When squeezing nipple with her fingers, it does NOT change color.  She has felt pain in the same spot, on 1/3 of her breast tissue, near where her ribs meet her body, at the inner portion of the breast.  It is deep into the tissue, but she also said that it changes, which is why it stumped all of the medical personnel she sought out.  I thought it was a latch problem, and we talked about vasospasm.  She was researching Raynaud’s when someone suggested that. She has had mastitis 2xs, complete with fever, so she is aware of what that feels like.  I thought perhaps teething.  She did seem to think it was timed with teeth coming in. There is a very intense throbbing pain, at the nipple at times, too.  Like a twisting burning pain that is recurrent on the same side (right side).  I suggested skin to skin biological nursing to work on a nice latch, in case it was due to teething.  I suggested lecithin in case it was a leftover clogged duct.  We talked a little bit about Raynaud’s, but not as much as latch since Raynaud’s was already suggested previously.  I also suggested laying down to nurse.  She is to the point now where it is really affecting her will to breastfeed.  Because her left side is doing so well, the pain with the right side is almost unbearable and is frustrating her and she wants to do everything possible to continue nursing, but just cannot nurse through the pain any longer.  She is on vacation visiting family and will get back to me this week if anything has helped or not helped.  I sent her the kellymom.com link on blanching and the llli.org link on vasospasms.  Thoughts? Suggestions?
>
> Many thanks,
> Amberly Renfroe
> LLL of Vail Valley
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