Robin, 

My second baby was born in 1990 and a poor latch gave me sore and cracked
nipples and I developed a plugged duct which I did not treat.  It developed
into mastitis, but I didn't recognize that since I don't remember having a
fever or any of the body aches that I see in my patients with mastitis.  I
didn't call for help until I developed an absess when my baby was about a
month old.  It was just a very sore red spot to me at that time, though now
I know better. 

I was sent to the emergency room where the surgeon saw me nursing my son in
the waiting room.  She was able to drain the incision and sent me right home
(not her preferance) so I would not be separated from my baby with an
overnight stay.  She told me not to breastfeed on that side until it healed
since the breast infection could be transferred the other breast.  I knew
that mothers could feed twins, so I figured I could simply feed him from one
breast.  I didn't pump since I knew little of this as I was a stay at home
mother and never pumped for my first baby.  Looking back, my breastfeeding
knowledge was sorely lacking.

Somehow, I didn't develop any more plugged ducts and the right breast did
start to involute.  My baby increased the supply on my left breast and when
my absess was healed I did put him to the right breast once again.  He
accepted it and went on to nurse for nearly 3 years.  That baby preferred my
unaffected left breast to the right breast for a very long time (I can't
remember if it was months or years) and I think that breast never developed
the full milk supply that I had with my first baby.  My next two babies
nursed successfully for 5 years each (with some tandem nursing) and there
was no difference in milk supply or breast preference.  

I have learned so much since this experience and my second baby probably
helped define my current career path.  I later became a LLL leader and
learned that I didn't need to stop nursing on the affected breast since the
incision was far enough from his latch and that I should have pumped while
not feeding on that side.  But I did successfully relactate on the affected
breast and my baby was never supplemented with any formula.  

I hope this helps.  I feel for the mom as this really complicates
breastfeeding and I hope she finds the support she needs.  

Tricia Cassi, BSS, ICCE, IBCLC
Vermont



-----Original Message-----
From: Lactation Information and Discussion
[mailto:[log in to unmask]] On Behalf Of Robin Roots,Rn Ibclc
Sent: Wednesday, March 05, 2008 1:27 PM
To: [log in to unmask]
Subject: Need help/advice


Yesterday I was  in to the hospital doing rounds when a nurse asked me to 
consult on a woman 6 weeks post-partum mom who had a abcess on her right 
breast, and was going to have a I and D (insicion and drainage)  The surgeon

(believe it or not) asked me where to put the incision so she could still 
breastfeed and/or pump.  Sounds great huh?  Keep reading... I explained 
where the flange would need to be placed and could he make the incision 
higher than the flange would go.  The abcess('s ) were two palable lumps at 
12 o'clock and 10'oclock positions right breast.  When she pumped that side 
prior to surgery you could smell the infected milk. The skin was distorted
due 
to the swelling etc.  He made the incision close to the aerola border.  Her 
aerolas  were larger than the 24mm size of the flange.  Unfortunately, when 
she returned to her room and I took a look at the breast,  the incision was 
larger than I thought it would be. It was a open 3 to 3 1/2  incision with 
packing inside. I was expecting to see something like the photo in 
the "breastfeeding atlas"  book. The flange would now be right about where 
the skin is open and there is now way she will be able to pump that side.
It 
would be pulling the skin where it is trying to heal.  We banaged her back
up 
and I put ice packs around the breast area to help reduce swelling etc.  At 
this point, I don't know how she will be able to remove milk from that
breast.  
When talking with the other LC we both agreed she probably is gonna have to 
leave that breast alone  with no stimulation.  Mom is okay with feeding on
one 
side only and has a great supply.  My question is has anyone delt with this 
situation before.  Will her affected breast become infected again if we
don't 
drain the milk?  She is of course on antibiotics.  Putting the baby to the
breast 
or pumping is out of the question now due to pain.  Should we just try to
get 
the breast to involute and  just leave that side alone?  Should she try to 
establish milk after she has had some time of healing?  She is being
followed 
by a private practice LC and probably home health, for wound care and 
dressing changes. She may or may not get the home health service, since she 
can "drive to the doctors office"  Its all about insurance and cost.   YUK!
I 
have been in contact with her LC and we are giving it our best with a team 
approach.  Any suggestions from someone who has been thru this would be 
appreciated.  You can e-mail me privately or on the list.  Our hearts go out
to 
this mom and baby.  What an ordeal they have been through.  Thank you for 
reading this long post.

Best,
Robin

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