I have encountered this a few times.  In the first situation, the mother's
nipples had been pierced twice, with slightly different positioning.  I
worked with her through two children, and with each child her milk came in
as expected but her babies just could not gain weight. She could hand
express or pump tiny amounts of milk from one breast, but nothing from the
other. The theory that this mother and I generated together was that the
placements of her particular piercings had severed ducts. As her body
healed the piercing site those severed ducts eventually became dead-end
streets for milk, and although she appeared to produce plenty, almost none
could be removed.

In the second instance, the mother had a big ball of adhesions and scar
tissue where her piercing had been and had healed over. She was unable to
express from this breast only, the other nipple had been pierced as well
but she did not have the scar tissue, and this breast could be expressed
just fine. She also had a lot of pain with latch on the side with scar
tissue, which I imagine felt similar to the pain women experience with
nipple bleb; the nipple elongation implicit with feeding probably put a lot
of traction on the inelastic scar tissue. In this instance I had the mother
knead, massage and stretch her nipple several times per day for a few
minutes at a time. She also received therapeutic ultrasound to the nipple
from a physical therapist. These interventions seemed to break down the
adhesions and scarring and she was eventually - after about 4 weeks -  able
to express a generous amount from the affected breast.

I have in the time since I worked with these women also had my nipples
pierced, which has given me a tiny bit of extra insight into the possible
mechanics of the problem with milk expression. But there are two forces at
work that could potentially affect breastfeeding after nipple piercing.
First, some piercers utilize a very large gauge piece of jewelry with the
initial piercing to allow for swelling, and allow women to size down after
the piercing has healed, usually 3 months or so after it was done. These
larger gauge rings or barbells probaby affect more ducts than do
smaller-gauge ones. Second, some piercers are uncomfortable piercing the
shaft of the nipple and instead pierce the junction of the nipple and
areola. Others will do the nipple shaft. I imagine the location of the
piercing varies also with nipple length and elasticiy. Although I have not
looked for any peer-reviewed evidence on this topic, and I would love to
see further discussion on this, my gut tells me that piercings at the
nipple-areolar junction likely cause more trauma to functional lactating
tissue.

I'd like to close by saying that although I rarely post, I read Lactnet
avidly and am so appreciative of both the wisdom and the warmth I find
here. I love being part of this community,

Sarah Stevens, MPH, IBCLC

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