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Subject:
From:
Brenda Dalton <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 26 Feb 2005 12:14:00 -0500
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Hi,
I have a new client 2weeks postpartum (permission to post) who had her
breast implants done through her belly button 7 years ago, she went from a
round A cup to a D cup (she is very small framed).  She told me that the
implants were placed in front of the muscle.  Upon exam, her breasts are
very ROUND with a spacing between breasts.  The tissue is very taut, with
visable veining. She feels that she is no longer engorged, just full.  Her
nipples are everted, yet the shank is not extreemly long (1/4" to 1/3").
7lb. Male baby with normal oral structure with no tongue tie or labial
frenulum, tongue lifts well,(digital exam done after first side was
complete), shows baby bunching his tongue only with the first few sucks,
then cups appropriatly and sucks strongly. Upon return to the Pedi office
at 1.5 wk, he's regained his birth weight plus 12 oz.

To make a long story shorter, her baby latched on well and was bf on
discharge from hospital.  At her initial visit (at 5 days) with Pedi, baby
was jaundice, and had lost weight :(  SO the obvious treatment was to ABM
Or EBM feed with a bottle until both problems were resolved.  She did so
with a Avent bottle/nipple.  Thankfully she had the knowledge to pump at
least every 4 hours and give EBM, and is now able to pump between 6 and 8
oz each time, while the baby only takes in about 3 oz each 3 hour
feeding.  NOw she can't get baby back to breast.  Initally we attempted to
latch baby onto her breast in 2 or 3 positions, baby appears unable to get
wide enough mouth to latch deeply, causing mom to complain of pain with
inital latch - now I'm thinking that because the breast tissue was so
tight he couldn't latch on - she was unable to sandwich nipple/breast.  He
roots appropriatly. Mom very eager to get him to breast she wanted to try
a nipple shield, so after applying, were able to get baby latched on, of
course not as deep as I would like, but deep enough for baby to transfer
milk, and was satisfied after feeding.  We discussed attempting direct bf,
and before frustration set in use the shield, frequent feedings as the
baby adjusted to bf with shield, insurance pumping, stopping the use of
pacifiers (which was limited already).  She called me the next day and
said that her nipples were already becoming sore and itchy (no visable
sign of thrush on initial visit), baby feeding frequently.  Encouraged her
to continue to try deep latch, and if unable to do so without pain revert
back to using bottle in a "paced" method with a shorter teat.  I am seeing
her again on Monday, I didn't think of telling her to attempt to pump her
nipple out, and soften her breast before attempting latch on, which I will
do.  She finds side lying their best position.

My questions to you... Have you ever had a women have her augmentation via
the belly button?  Would that pose any problems? (she has adaquate milk
output at this time and full nipple sensation).  Does augmentation cause
increased nipple sensation?  What methods have you used to promote a
deeper latch on a tight breast?  Any other ideas/tips would be greatly
appreciated.

Brenda Dalton RNC IBCLC

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