Those of you with experience working with women who've had reduction
surgery: I need your input!

I just got off the phone with a woman who has been nursing her 5 day old
son. Five years ago she had reduction surgery-- per her description "a
classic anchor incision." The surgeon who performed the operation told her
he would "preserve the breast function." This woman had no labor medications
and had hoped to feed the infant within the first hour after birth; however,
she reports that he had a sepsis workup and was in the NICU for 48 hours
(I'm not sure why--I only took a brief history on the telephone. Tests and
cultures were all negative.) She was discharged at 48 hrs and has been
nursing for the past three days "full time." She says the baby has been
having more than three stools each day and lots of wet diapers. He will have
a pediatric check-up tomorrow.

The problem is that the pain in her breasts has become so bad that she
doesn't feel she can continue. A (nurse? LC? someone she talked to
yesterday) told her to try pumping "because then you can tell if it is pain
from the baby's latch or your breasts." :-(  So, today she began pumping
using a Medela mini. She called me after finding that the pump hurt the same
as nursing. She has been able to pump 1.5 oz from L breast, but negligible
amount R.

I haven't seen her so I don't have an informed opinion of my own, yet.
However, the mother is convinced that the pain is coming from scar tissue.
She reports that the pain on one breast radiates along the suture line. Both
areolas and nipples "feel like I have pins and needles stabbing me." When I
suggested she try hand expression she told me that the pain at the edges of
her areolas is so intense she can't compress the tissue. She is afebrile.
Her R nipple is cracked.

I advised her to stick with the ibuprofen regimen her MD advised (600mg q 5
hours) and to experiment with ice treatments and warm soaks. Her family is
very supportive of (and experienced with) breastfeeding; however, now that
they have seen the pain she has been through their enthusiasm (along with
hers!) has flagged. I encouraged her to continue nursing and/or pumping
tonight as best she can.

Any ideas? I've worked with women who've had reduction but never had anyone
complain of pain like this. Yeast crossed my mind when she described the
pain sensations; however, as I mentioned, she describes the pain in one
breast as radiating along the incision. If you've had anyone with similar
symptoms, did they improve after the first few weeks?

Margery Wilson, IBCLC
[log in to unmask]