I have been asked about a situation that I could use some extra brain power
on.

Patient is a 38 year old woman who delivered a baby on 12/11/00. She has
been complaining of a continued "tenderness" in both breasts. She uses the
word "tenderness" to describe what it feels like when she touches the
area.  The more pressure that is applied, the more severe
the "tenderness".

Due to her family history my patient has had annual mammograms, with her
first being 4/95. She has had 2 biopsies on the left breast, one in 4/98
and the other 8/00, both being fibrocystic.

In 4/00, her mother, at the age of 61, died of breast cancer.  Her maternal
grandmother died of breast cancer, and one of her mother's sisters had
breast cancer, but has been cancer free for nearly 6 years.

Baby is now 11 weeks old and mom has been breastfeeding since birth, with
the exception of a few bottles of formula.  About 3 weeks or so into
nursing she noticed pain in her right breast, along with a warm, red spot.
Initially, she didn't have the flu-like symptoms. Thinking it was mastitis,
she called MD and was placed on Dicloxacillin, which within one day caused
severe diahrea.  On 1/10/01 she began taking Cephalexin, 28 doses, 500mg.
While it cleared up the warm, red spot, she still had the "tenderness" in
the bottom portion of her right breast.  She was also using hot packs, 2-3
times per day.  She was placed on another round of Cephalexin on 1/25/01,
but the "tenderness" still remained.  Her MD ordered an ultrasound to rule
out absess or inflamatory breast cancer--neither were found to be present.
She was then placed on Clindamycin on 2/1/01, but unfortunately experienced
an allergic reaction. She became frustrated with the side effects of the
antibiotics and quit taking them.
She continues to experience the "tenderness" in the bottom portion of both
breasts, with it being more intense on the right breast.  The majority of
the time they're only tender to the touch, but there have been a few days
where she describes holding her daughter lightly against her chest to cause
pain and not just "tenderness".

In the last 7-10 days, she reports that the sensation of
"let down" has increased significantly in intensity and during the first
3-5 minutes of nursing she is experiencing more pain.

She is pumping once per day with an electric pump and consistently gets
only about 2 oz. out of the right breast, and can easily get 3-4 oz. from
the left breast over 10 minutes. She wears a cotton bra--no underwire.

An thoughts or suggestions would be much appreciated.

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