At 20:37 13/9/00 -0400, Karen wrote:
>breast fed her first child and, as a result of undiagnosed mastitis, she
>had two surgical procedures under general.

Not sure what these were - possibly drainage of one or ?two breast
abscesses. Not diagnosing mastitis is a difficult thing to do - did you
mean 'untreated mastitis'.  If not, perhaps she never had mastitis at all
and it was a galactacoele that was operated on.

>is it
>possible that milk ducts were sufficiently disrupted as to cause an
>inability to nurse.

I wouldn't think so Karen.  Reduction mammaplasty disrupts the milk ducts
even more and still most mothers who have this surgery are able to either
fully or partially breastfeed.

>I am assuming that only one breast was operated on but I don't know that
>for a fact.

If it was only one, and the surgeon did have a picnic in there, then she
still should be able to fully breastfeed her infant from the unaffected
breast.
I suspect the surgeon told her not to breastfeed as his way of preventing
breast abscess reoccurring in her.

>Also, I am looking for your best advice on what to tell her to prevent
>the possibility of developing mastitis again if she does BF this baby.

-ensure good latch
-finish the first breast first
-gently massage to clear lumps as they appear
-avoid nipple damage
-eat well, rest well, stay well

These are the basics and not attending to them has been shown to be the
most common causes of mastitis.  I really can't think of anything else I
would tell her at this stage.  Perhaps after she has had the baby you may
need to check the area around the old incision sites and apply cold
compresses/cabbage leaves if it appears that some severed ducts aren't
allowing a section to drain - this will let these sections involute while
the rest of the breast functions normally.

Incisions probably weren't near the lower outer sections of the areola,
which would impact on the milk ejection reflex.

Karen I think my management at this stage would be just to give her good
information, preferably written, on how good breastfeeding is.  To have her
committed to wanting to breastfeed before she has her baby will be 95% of
her problems solved - then just good breastfeeding management will
hopefully prevent anything further from happening.

All the best
Denise



****************************************************
Denise Fisher, BN, RN, EM, IBCLC
BreastEd Online Lactation Studies Program
http://www.BreastED.com.au
mailto:[log in to unmask]
****************************************************

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