Margery writes that she has spoken by phone to a mother who is in early
lactation who had reduction surgery sev. yrs ago.  This mom is experiencing
intense pain along suture lines.  I have several comments about the
situation. First, the use of a phone consult in such situations is fraught
with danger.  This mother must be seen to be properly assessed.  I'm sure
the visual impression would reveal things not apparant over the phone.

Perhaps the surgeon was more sanguine about preservation of function than is
the true case.  The pain along suture lines could be related to severed
ducts in these areas which in early lactation would contribute to severe
engorgement and inflammation in the severed lobes.  These areas will
continue to hurt until those areas shut down, atrophy and involute under the
pressure of all that unremoved milk.  If mother is taking lots of ibuprofen
for pain, she may be masking febrile sx. Has she seen an MD to rule out
mastitis? Pumping with a Mini-electric has not proven esp. useful for
mothers I have worked with who have pathologic engorgement.  They need to be
using a hospt. grade pump.

I would try cooling off the breasts to see if reducing swelling would
unblock things and she could pump more effectively.  I agree with Mary
Broadfoot, and all those who have posted about the inflammatory nature of
mastitis.  I use cold almost exclusively. (A LITTLE ibuprofen might help
with the inflammatory sx.)

She also has a cracked nipple.  It would be useful to visualize the wound.
If its a positional stripe, one might deduce that poor positioning had
contributed to the engorgement by virtue of poor drainage.  You might in
that case have a bad situation totally or partially attributable to poor
management and coincidental to the surgery. You might also have some severed
ducts, some effects from the surgery AND poor management.  If the wound
looks like a sort of star-burst in the center of the nipple, that may be a
sign that baby is sucking very very hard to try to get milk out of a breast
that is really not connected up any more -- or at least not totally connected.

Its so hard to tell with these post-surgical situations, but I agree w/
Maryann Niefert's research which indicates a three-fold increase in risk for
lactation difficulty if mom has had any kind of previous breast surgery.
You need to visualize the locations of incisions and everything else to get
an idea of how to proceed. I had one mother post-mastectomy who had phantom
pain in the area of the missing breast (or rather perception of pain in her
brain from the severed nerves in her missing breast.) Perhaps this
phenomenon might occur if nerves have been severed even tho the breast is
still there?  I'd be interested to hear if people think the scars would
ache.  I have seen moms post-abscess surgery with scars which ached.

Barbara Wilson-Clay, BSE, IBCLC
priv. pract. Austin, Tx
owner LACTNEWS On-Line:  http://moontower.com/bwc/lactnews.html