You have tried a lot of things, but here are a couple more ideas to kick around -- nature didn't think ahead about us pumping, so it sometimes does take the ingenuity that you are showing.
It's hard to picture an overdose of lecithin, so certainly a higher dose seems worth trying
APNO  is generally just for short-term use -- the hydrocortisone can sometimes thin and irritate the skin after a while. 
 Lanolin is sticky, so if she does a pre-pumping massage and lubricates the flanges with olive or coconut oil (which also has a gentle anti-fungal quality), and lubricates the flanges, the skin may slide more easily.  Lovely breast massage/hand expression video at http://bfmedneo.com/resources/videos/
Has she tried the Pumpin' Pals flanges, which have more of a slope than that sharp angle. 
Is there any constriction with the bra?  or the hands-free pumping rig?
Has the mother had a good check-up, for anything systemic like anemia or thyroid issues or vitamin deficiencies, which can contribute to persistent plugged ducts
Has anyone cultured the skin and milk?
There are some great posts in the Lactnet archives on anti-inflammatory diets, which certainly could be worth discussing.  Going from the positive angle --  trying to fill the house with food she can eat, since she is tired and busy, and it's hard enough to get anything to eat, and dairy, wheat, and sugar are in a lot of things that are easy to grab.
There were also some great recent posts on research with probiotics being used to treat mastitis.  There have probably been lots of antibiotics, even prior to the recent course, so probiotics are probably useful on many levels. Not just eating some yogurt, but a good wide spectrum supplement.
Maybe going back to trying the Symphony again -- everything is changing, and it may feel different to her now -- many mothers feel that it is a pretty smooth, gentle pump.   Is there an old Classic pump hanging around anywhere?

Are the babies able/willing to do anything at the breast?  There's some nice research with mothers getting a better let-down pumping after skin-to-skin time and the babies mouthing the nipples (which also exposes her to their germs, and targets the immune factors in her milk).  so there's no down-side to lots of practice with the babies as possible.  Point out how much cuter they are than the pump!

Good luck to the whole team. 

Margaret Wills, IBCLC, Maryland

 

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