>>My questions are: Why would a scar above the areola affect the texture of
the areola? and what other suggestions might be appropriate for this
mother?<<

You mentioned that the scar was above the areola, but not how large the
areola is to begin with; I'm wondering whether this is area that the baby's
mouth should reach or not.  My thoughts:  it seems pretty obvious that the
surgery for the duct disturbed the functionality of that duct, and maybe
others besides. Perhaps it was even severed completely, which would explain
the "lump" in the upper breast and the flaccidness of areola.  In the
meantime, it makes further sense to me that the nipple may not protrude
properly-- this could be due to the scar itself, if it is part of the tissue
that should stretch, or it could be that the skin is already stretched tight
because of the swollen upper quadrant (you know how nipples can disappear
during engorgement), or maybe the surgery itself  altered the position and
"anchored" the nipple with scarring inside.  All of this is pure speculation,
of course, but makes potential sense.

As for how to handle it: I think that your LE got off to a good start. Ice
and/or cabbage on the area of stasis, then heat before pumping/feeding
attempts. I'd add to heat some gentle massage, stroking downward  from the
lumpy area to the nipple, to see if any milk can be manually moved forward.
Also try this during pumping to see if any new ducts open up with milk to
verify the effectiveness of this procedure.  If all fails and the milk is not
moveable, the mother will face involution of that area and definite
compromise of her feeding ability on that breast. If the backed up side
cannot be broken free, then cabbage compresses would probably be the best
measure until milk production ceases in the related lobes. The good news---
she can still breastfeed fully, of course, with the other breast!

One last thing-- you might consider contacting the surgeon and finding out
more about what the surgery entailed and if ducts were indeed severed, etc.
Ask about potential scar tissue, and let him know what you are observing and
see what he has to say, as this may well validate your decision in how to
proceed.

-Lisa Marasco, BA, LLLL, IBCLC