Hi Jennifer,

Very interesting and well presented case study.

 I thought of several things. Contact Cathy Genna as Pat suggested, she is
well connected to resources I believe. Ultrasound as diagnosis and/or
therapy?

Next, I am thinking a (congenital? )  agenesis of some of the ducts? or
some malformation therein, or maybe scar tissue with mastitis during the
first lactation. But it seems something is up with that breast/nipple and
regardless of tongue tie, it is prone to poor drainage/masitits. In any
case, milk is being produced but cannot exit.

I think when milk does not flow, we use too much heat. I think cold. I like
(reverse ) breast massage to facilitate lymphatic drainage (I watch videos,
I am no expert), then RPS for letdown, then hand expression or pump, then
cold on the lumps. I like anti-inflammatory over the counter med and
probiotics.

Some moms manage better with hand expression or a simple manual pump. Less
is more, again.

If shield didn't help, discard it. I don't think lecithin or castor oil at
this point. Less is more for this mom. I think worthwhile to see if can
manage to get some production from L breast, it likely will never ever
produce "normal" amounts. But ultimately up to mom, of course, to pursue
this or involute.

What a challenge!

Laurie Wheeler RN MN IBCLC
Beautiful Gulf Coast Mississippi USA

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