Well, just as I was starting to close up shop for the day I received an
alarming and complicated request from a former client.
Here are the essential details of the problem:

Baby is 9 mo old,  still breastfeeding.  Mom had mastitis during first few
weeks postpartum, tx with abx and seemed to resolve fine.  About 3 weeks ago
she noticed  a small lump near or along  the scar line from her implant
incision (under the mammary fold).  She was due to get reg. physical exam,
and showed it to her MD.  He suggested she see plastic surgeon.  Appointment
was not considered emergency, so she called on her own and got one sched.
several weeks in the future.  Next day woke up with pain in that breast, no
fever.  Phoned OB to describe sx that she assumed (from past exper)
indicated mastitis,  and augmentin begun.  Next day red spot appeared over
the area of localized pain, and then all along the scar line there appeared
puffy swelling and redness.  She reported this to MD who suggested trying to
get in to see the plastic surgeon earlier.  Earliest available appt. was 4
days later (today).  Abx has cleared up the red spot, but incision still red
and thin looking.  Plastic surgeon urging immed weaning.  Wants to remove
implant, suspects pocket of infection in scar tissue that has formed around
implant.  Thinks there will be a week-long hospt. stay with IV abx.  Will
then use oral abx for 1 month and then reexamine breast to see whether
another implant should be inserted.  Her question to me concerns safety of
emerg. weaning.  She is worried engorgement may stretch the thin scar tissue
and cause it to rupture.  The plastic surgeon admitted he doesn't know
anything about lactation.  The nurse at the OB office said just don't nurse.
If she has an abscess, I'm afraid about the risk of abrupt weaning.  I don't
know the plastic surgeon and don't know if he will welcome my input.  I am
going to fax him info from Tom's book, and the info on emerg. weaning from
Lawrence (not much).  I don't know what drugs he wants to use, altho she
could pump and dump if nec. and I told her about unilateral weaning.  I have
no experience with infection related specifically to implants, nor have I
personally seen the breast (will do so tomorrow). Anybody with any great
ideas on this situation?

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html