Candida spores can be washed off intact skin, so if the mother doesn't have
cracked nipples from nursing (she is only pumping) it would surprise me if
this were yeast.  She could have a subclinical or chronic inflammatory
mastitis going on, and some signs like the clogged ducts point to this.  I
have seen mastitis NOT present with fever, and one of the breast surgeons I
work with says 25% of the abscesses he sees are not initially accompanied
with fever.  So I don't think mastitis can be ruled out. However, as this is
a woman who is exclusively pumping, it may still be pumping technique.  I
wonder if her nipples are a good fit with the standard size pump flange.  If
the nipple diameter is nickel size (an American coin that is about 20mm in
diameter) she may swell during pumping and the shaft sides of her nipples
may rub abrasively on the flange.  Try a larger flange and lower pressure
and reassure her that 10 min per pumping session is sufficient.  I've seen
depressed moms of preemies really injure themselves with aggressive and
inappropriate pumping techniques.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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