>Now, one of her nipples looks like it is coming off.  There is a 200 degree
>split which looks much worse after baby nurses.  It looks like it's hanging
>off by half.  A lactation counselor looked at it and said she should wean
>her off the breast immediately,  but the mom is so determined to bf for a
>year- she is crushed.  Mom went to a surgeon who told her that she had a
>"Cleft nipple" and that she should pump and or manually express for 1-2
>weeks while it healed some.  He also told her that the nipple would not come
>all the way off and that it also would not heal all the way back.

I'm going to go out on a limb here.  I've seen a few nipples - what Chele
Marmet would call adhesed nipples - that seemed to need to heal in the "torn
open" position.  That is, they rip open during a nursing, settle back on
themselves afterwards and start to seal, only to rip open again at the next
nursing.  But if the mom wears shells to allow their continuous extension
and uses APNO, the torn-open area begins to fill with new tissue.  The
nipple ends up being a more extended shape than before (the mom may even be
able to point out the new tissue) and there's no further problem.

I don't know why this would happen so late in the game - 5 1/2 months - but
I *did* see one mother who had more trouble with her second baby than she'd
had with her first, and ultimately healed in the "torn open" position.

If I could do anything I wanted, I'd have her on a systemic antibiotic as
well; certainly an infection of long-standing could be behind long-standing
pain and the ultimate deterioration of the nipple.  And I'd culture first;
one mother grew "weird bugs" when her milk was cultured after baby #2, when
she was having the same nipple deterioration she'd seen with baby #1.  Made
me wonder if it had been an infection of *very* long standing...
--
Diane Wiessinger, MS, IBCLC  Ithaca, NY
www.wiessinger.baka.com

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