Karen describes a really damaged nipple following reduction surgery.  When
milk supply is decreased or let down is slow (as well might happen if the
interior nerves and ducts are impacted from surgery) then baby will suck
more aggressively trying to stimulate and to access the available milk.
This chronic trauma has obviously damaged the nipple.  Wounds won't heal:
a) if they are infected (presence of mastitis indicates that prob. pathogens
are constantly contaminating the wound and migrating up into the breast) and
b) if the trauma is on-going.

I agree with Laurie's suggestions.  Clean up the wound, rest it, and pump
until it heals.  Then perhaps try a feeding tube to supplement at breast.
Increasing the flow rate of milk being delivered will reduce the sucking
pressure baby applies to the nipple.  This will reduce trauma and allow
mother to cont. to do what she desires.  But first she has to heal the
nipple.

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

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