In a message dated 4/29/1 9:33:22 AM, Diane W writes:
<< What's different about my current client is that she nursed a previous
child
for 8 months. She had a miserable first month or so, and she can't remember
what her nipples looked like before or after that child. When I saw her at
2 weeks with this baby, she had flat, dimpled, fissured nipples - much like
those cloth models with the string pulled tight - and we've been unable to
clear up the thrush-like splits that occur with each nursing. So we're
going with shells and APNO, trying to heal those splits without having their
edges come back together. I have my fingers crossed, because thrush remains
a possibility.
Has anyone else seen anything like this? Are there any better
explanations/treatments/names? >>
seen it, yes. regarding explanations for the mom you are currently working
with, variables may include:
1) the recent lactnet discusssions regarding variations in breast development
with each pregnancy, ie: for the mom you are working with, her current nipple
variation may be a more involved variation of her previous nipple anatomy,
combined with the possible thrush issue this time....
2) something may have happened during or after the last pregnancy/pp to
increase the severity of the variation she previously noticed:
<<Bilateral or unilateral nipple inversion is most often congenital in
origin, but can also be acquired.
Ductal mastitis in early development prevents the normal elongation of the
ducts, or can result in scar tissue that in time retracts to invert the
nipple [Schwager 1974]
The acquired group also includes breast surgery such as reduction
mamoplasty, repeated inflammations [Megumi 1991], carcinoma, tension caused
by large penulous breast, [Schwager 1974] and trauma or inflammation
following pregnancy and lactation. This places the inverted nipple on a plane
beneath the areola, hidden in a sulcus from which it can usually be
extracted.[Hauben and Mahler1983]>>
3) also, according to some literature, as *nulliporous* women age,
their nipples may become more inverted/retracting due to tightening of the
ducts under the areolar tissue, maybe this is also the case with *multips*
but it just has not yet been documented/researched.:<<Slit-like retraction
can be the result of duct ectasia as the subareolar ducts dilate and shorten
during involution which in nulliparous women begins sometime after age
30.[Dixon 1994].>>
Regarding treatments, other than what you are doing - medicating the wounds
and shells to maintain a protracted position for healing, another treatment
I've read about, but not found the occasion to advocate for, - and it seems
way too drastic for your situation, and most others, - is surgery to correct
severe nipple inversion/retraction to facilitate breastfeeding. I've read
that in certain situations where the mom is absolutely unable to breastfeed
due to the severity of the nipple anatomy variation, she may choose to have
surgery before the next pregnancy. I would expect that it would take a very
breastfeeding knowledgable surgeon to produce a sucessful outcome. Depending
on the nipple anatomy, with cooperative areolar tissue, and with a motivated,
dependable, client, the dimple rings may keep the protracted postion better
than the shell... and, Nipplette also comes to mind as a device to keep
nipples protracted, but .... expensive, not easy to use, no air
circulation......
In your current case, since in the mom's previous experience her condition
improved after a month, and even if her condition is worse this time, if she
will continue with your support, it is likely that she will experience
improvement.
Debbie Tobin
RN BSN IBCLC LCCE
Springfield, Virginia USA
In the Fairfax County suburbs outside the Washington DC beltway
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