Dear Ann,

Vasospasms of the nipple are related to blood flow.  Raynaud's is a
particular kind of vasospasm and has a particular kind of history, such
as the sensitivity to cold you mentioned.  Mothers who have had severe
nipple trauma which may have compromised blood flow may also experience vasospasms.

My best guess would be that when a nipple is removed for reduction
surgery and then replaced, as in your client, there will be significant
interruption of the vascular system as well as the mammary and nervous
systems.  We know that  mammary connections and nerve systems can
regenerate in such situations, especially if it has been some time since
the surgery, as in this case.  This can allow mothers to have nipple
sensitivity and a better chance of milk flow.  There will have been
regeneration of the vascular system or the replaced nipple tissue would
die.  What we don't know, as with the sensitivity and recanalization, is
to what extent.  I can easily imagine a situation where the blood flow
could be impacted enough to cause vasospasms of the nipple in this case.

You might suggest that the mother "test" the theory by having her keep a
heating pad and a wet cloth in a baggie close by.  The heating pad, set
on low, can be folded over the baggie to keep the cloth warm.  As the
baby comes off the nipple, she can take the cloth and place it over the
nipple.  If she gets comfort from this and sees that the nipple does not
go through the color change, it is likely that vasospasms are the cause
of the burning.  That may be all she needs to do.  If the burning
becomes severe or painful, she may want to consider a course of
nifedipine as described in Dr. Jack Newman's book.  I have seen that to
be very effective for women with Raynaud's and could be of help to this
mother as well.

I hope this is helpful to you and your client.  Please send an update to
add to our collective knowledge.

Warmly,

Cindy Garrison BS, IBCLC
southwest PA

>
>
> Subject: Raynard's of nipples for mom with breast reduction surgery
> Date: Wed, 28 Sep 2005 21:38:57 EDT
> From: Ann Perry <[log in to unmask]>
>
> Hi Diana,
> I am working with a mother who just delivered and had breast reduction
> surgery 10 years ago.  She had her nipples removed during the  procedure.  She has
> good sensitivity in both nipples and can easily express  colostrum at this
> time.
> She was delivered by c/s today and the baby was great self attaching.   She
> stated that as the nursing continued she felt a burning sensation but said  it
> was tolerable and the latch looked very good.  After the feeding when  the
> baby came off the breast, the whole nipple was white.  After a minute  the nipple
> came back to its normal color.
> The Mom denies any problems with cold sensitivity or history of  Raynard's.
> Do you know if women who had the nipples cut are prone to Raynard's?
> Thanks,
> Ann

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