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Mom had nipple eversion surgery in 2009 for inverted nipples. The Dr made 4 incisions around the outside of the areolar, and then made some incisions at the base of the nipple inside, from the incisions at the edge of the areolar, to dissect the restrictive tissue. He then used a fishhook type tool to insert in the nipple to pull it out to evert it. Sutures were put in place to hold the nipple out while healing occurred. 

Mom has breasts that are filling, (they certainly feel as if milk production is underway) but is unable to hand express any milk. When I try to hand express it looks as if she has a nipple bleb forming. There is a layer of skin over the nipple that looks like the skin on my hand, in other words, just like regular skin, vs nipple skin which is different and almost multi-textured. Her areolar skin is also smooth. 

Does anyone have any experience with this type of surgery? I have not worked with a mom in this situation before and am unsure about what to do. Baby is nursing on the breast, but I am not convinced transfer is occurring. Baby was 1 day old when I saw her today. I will see her again tomorrow morning and am hoping to have some insight as to how to support her through the next steps.

Thoughts I have had: treat as for a nipple bleb and see if the skin can be removed enough to see if what I think is milk trapped under the skin is milk and can we find patent ducts. Concerns I have are more nipple injury and damage, and I am not sure that regular treatment for blebs would be effective in this case, as this doesn't appear to be a case of a single layer of skin growing over a duct but all the layers. I also wonder if the surgeon maybe just created nipples during the surgery rather than everting the actual nipple? Is what is now everted the actual nipple tissue, or is only part of it nipple tissue and part of it areolar tissue?

Try pumping on top of breastfeeding, to see if we can get milk transfer. Concerns I have are that I am increasing supply with stimulation but the milk has no where to go, thereby putting mom at higher risk for engorgement, plugged ducts and mastitis.

My other concern of course is baby, and based on how baby is doing will determine the need for supplementation. In honesty I am not sure baby is any more successful in transferring milk than I was with hand expression, I really do not see any patent ducts at all. 

If anyone has any ideas I would really appreciate it, I have to admit, this case has me scratching my head!

thanks in advance,
Sonya

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