Dear Beth,

Lawrence in her 1994 edition of  BREASTFEEDING: A GUIDE..., on page 42, probably
suggests the same that you have in the 1989 edition: "...swelling and
secretion... may produce pain during lactation.", "...can cause discomfort and
embarrassment...", "In rare cases, it may be appropriate to surgically remove
the tissue...", "If treatment (referring back to the surgery) is not initiated
before pregnancy and lactation ... pain and swelling will be intensified and may
progress to mastitis or the necessity to terminate lactation.". Additionally,
she reviews findings by Alder et al (Accessory breast tissue in the axilla:
mammographic appearance, RADIOLOGY 163: 709, 1987.) of 13 women who were
diagnosed on routine mammography. Seven had a mass or fullness on examination,
ONE  was seen postpartally for pain, and NINE were asymptomatic. Also, Susan
Love in her book, DR. SUSAN LOVE'S BREAST BOOK, 1990, page 51-2, suggests that
this accessory tissue is often unnoticed by both doctor and patient, and
although subject to all the problems of normally situated tissue, her experience
with one patient with this unusual circumstance was that the swelling went away
upon weaning from the breast (doesn't say when this weaning happened). She
suggests to do nothing unless the tissue causes extreme discomfort or
psychological distress.

I have only seen two women in my limited experience since getting into this
field in 1980 with accessory mammary tissue: one mother had an extra nipple only
(no problem), and one mother had a nipple and supporting glandular tissue (
swelling, leaking, with eventual involution from disuse).

IMHO, I think that the woman should plan to breastfeed, be informed of comfort
techniques for swelling and pain - maybe cabbage leaves would help here - pack
your phone number with her labor/delivery supplies baggage, and take postpartum
one day at a time, like we all do. The Alder research gives one reason to
believe that she may have no other symptoms, or her symptoms may diminish with
breastfeeding duration, or her symptoms may be tolerable until she decides to
wean, at the very least she can enjoy a day or two of breastfeeding and her baby
has the advantage of the skin-to-skin contact (something we forget to encourage
in the non-breastfeeding mother) and colostrum. Unless her physician has a
specific reason that initiating lactation may be HARMFUL to her - maybe
something else unrelated to the accessory tissue that was not communicated well
to the mother - then I see no reason not to encourage her to give it a shot.

Two cents from the peanut gallery,
Jeanine Klaus, MS, IBCLC
Oakville, Ontario