I have permission from client to post:  Mom is exclusively breastfeeding and baby is 4 months, first child is 2 years old and was breastfed also.  Mom reports breast pain that started 3 days ago, is very intense for 1 hour after breastfeeding, then intermittent throughout the day.  3 days later, pain starting in second breast, both in medial lower area of breasts.  She reports that she had the same pain but only in one breast with first child at 4 months post-partum also, and it lasted several months, but didn't seek treatment with first.  It eventually resolved but she had pain for many months.  She has a hx of plugged ducts and an abundant supply but no symptoms of plugged ducts at this time, most recently had plugged ducts was 2 weeks ago while she was off work and breastfeeding with no pumping, resolved with massage and breastfeeding positioning.  While working, she pumps 2-3 times a day.  She also reports no rejection by baby.  She also, says she can "feel the pain during deep breathing" but no s/s of respiratory infection.  
    My suggestions:  1) watching for any pressure on middle of breast such as underwires, etc, 2) see physician for r/o mastitis, bacterial, or yeast infections, respiratory problem, and breast exam for any lesions, 3) check temperature twice a day for fever & call MD immediately if fever, 4) apply cool or warm compresses to area and observe for any pain relief.  I searched bf textbooks and I am wondering if she has pain caused by a fast refill or a vasospasm, especially with an abundant supply?  I considered a forceful ejection but textbooks say that pain from a forceful ejection usually resolves in first few months of breastfeeding.  She may have more supply than intake of baby at this time due to plugged ducts occurring when not pumping.  Any help would be appreciated by my client from all of you experts on LACTNET.  Thank you.  

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