Hi Kim
 I certainly feel
that the MVA could cause this mum's symptoms. Breast trauma can
permanently damage ducts/glandular tissue or cause scarring which will
reduce breast drainage. I have seen a woman in similar circumstances
who was lactating when she was involved in an MVA. She ended up with a
huge haematoma in one breast which needed surgical drainage. She
continued to feed from the breast for a while after surgery but then
weaned because she was pregnant again (her idea, not mine!!). When the
second child was born, she had problems with engorgement and poor
drainage from the affected parts of her breast, and I think she also
got mastitis (I'll have to check my notes at work). The symptoms did
reduce with time - I suppose the affected parts of the breast
gradually involuted as they weren't getting drained. I don't think she
followed it up legally, but I feel she would have had a good case. The
insurance company did pay for breastpump hire with her original
injury.  In your patient's case, simple things like different feeding
positions, massage, cabbage and heat might help. If one side
repeatedly blocks/ causes mastitis, then maybe one-sided feeding is an
option.

Hope this helps
Fiona
Fiona Coombes MBBS IBCLC               [log in to unmask]
Lactation Consultant, Family Physician
Perth Western Australia