I just had a mom come see me - and I am stumped!

 

She called me while I was out of town, reporting mastitis and "a small
abscess" under the areola of her left breast that was not responding to
antibiotics.  At a distance, we discussed what had already been done (one
and then a second set of antibiotics) and when she reported her pump did not
work on that breast, I sent her the video on breast massage and hand
expression, and also information about using warm compresses and expressing
from the tip back rather than trying to push on this lump. Eventually she
did get antibiotics that, she reported to me by phone, were reducing the
size of the "abscess" (as seen by ultrasound). She also said stopping the
pumping and going to hand expression, especially in the tub, was very
helpful.

 

Finally, today (2 weeks later) I saw her for the first time (I got back in
just in time to have cataract surgery).  

 

I'm stumped.  The left breast has almost a sphere about 2 cm in diameter
under her areola and very close to the nipple, from 5 to 7 o'clock that is
HARD.  When mom hand expresses, the pressure makes the nipple go in, but she
is able to express milk.  When baby tries to latch, though, she tries and
tries, but the very hard area just below the nipple is not pliable, and as
the nipple goes in rather than out into her mouth, she quits. (She also
knows mom has a great milk supply on the other side, and at 2 months knows
what she wants!) Mom can express milk using hand expression, but a breast
pump is ineffective.  

 

Baby is exclusively nursing on the right side.  She had been told her baby
was tongue tied, so a pediatrician had made a small clip, but I observed a
very loose latch, lots of clicking and interrupting the feeding. The tip of
the tongue extends, but the center does not move when gums are rubbed.  She
also has a fast gag reflex and a high palate with an area at the end that
may reduce the depth of the latch, and a lip tie that pulls the lip down.
She "leaks" when breastfeeding or bottle feeding.  Mom is an experienced (2
others) breastfed babies, so she is aware that this baby is nursing
differently, but as baby is gaining and  mom is in no pain, she is not
interested in having either lip or further tongue tie interventions.  

 

I have never seen a lump like this, and would appreciate your insights.

 

Jeanette Panchula, BSW, RN, PHN, IBCLC

Vacaville, CA

 


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