This morning I saw a 3rd time mother with a history of breast surgery 3
years ago for what started out to be an unidentified painless lump.  She had
weaned her second child one year previously at the age of 3 weeks, and
remembers that she had "gallons of milk", but he had cried all the time, so
she put him on the bottle.  She remembers no problems with the breasts
during the weaning period.  The lump in the left breast was removed, the
contents were found to be sterile, but she remembers the surgeon says it
burst as soon as he touched it.  Several weeks later she suffered
inflammation and pain in both breasts which led to abscess formation and
more surgery, on both breasts.  Several weeks later it happened again.  More
surgery on both breasts.  So she had three incisions on the left breast and
two on the right (scarring 10 - 2 o'clock on both areola, and a horizontal
scar right across the right nipple).  The areolas are misshapen, flat across
the top and indented, not round. The surgeon diagnosed "mammary duct
ectasia", and wanted to remove "all the ducts", but she refused. During this
time she remembers endless antibiotics and pain, but that any lab tests that
were done came back with the results "sterile".  She eventually took "garlic
and parsley tablets" and everything resolved.  One whole year later both
breasts flared up again, she took the garlic and parsley again and this was
effective.

Now she has a 4 day old baby, and thinks she doesn't want to breastfeed
eventually, but is open to the idea of getting him off to a good start for
the first few weeks, if this will be possible.  The left breast is firm, the
milk appears to be coming in, the left nipple is deeply abraded because the
baby has been breastfeeding often since birth from this breast (covered
latching and strategies to minimize further trauma/facilitate healing).
Milk transfer from this breast is low.  The right breast appears to be
making considerably less milk, only one tiny firm area at 12 o'clock and
neither she nor anyone else who has tried can express ANY milk from this
breast at all.  Manual expression by me produced minute drops from openings
that appear to be situated on the areola, near the nipple, not the nipple
itself, one at 10 o'clock and the other at 5 o'clock.  Baby hasn't latched
at all from this breast, but we covered how to present breast to baby and he
went on and sucked like a dream, appearing to SWALLOW occasionally.  The
baby is healthy and alert, has been breastfeeding often but lost 10% of his
birthweight by yesterday and has had 3 "brick-dust urine" nappies.  Mother
wants to start supplementing because he seems so hungry and I have to agree.

I have covered strategies to DRAIN these breasts as frequently and
thoroughly as possible, suggested repeat antibiotic (to make up to 10 days
cover instead of 5), suggested cabbage to help with potential engorgement.
Given info that if ducts severed and unable to drain then they will
eventually involute, if it is possible to drain these breasts then it is
imperative that she do this and decide on breastfeeding/weaning later (after
3 weeks).  Recommended daily follow-ups until we're sure of what will
happen.  Liaised with referring gynae who is happy to see mother in the next
few days and refer on to (different!) surgeon if necessary.  Permission
received to share case history with you!

I seek your thoughts on the above - anything more I need to look out for -
any other strategies to use?  And has anyone heard of "mammary duct
ectasia".  My (old!) medical dictionary defines this as "dilatation of the
collecting ducts of the mammary gland, with inspissation of gland secretion
and inflammatory changes in the tissues."    "Inspissated" is defined as
"thickened; made less fluid."
In the interests of speed I'd be grateful if replies could be e-mailed to me
as well as to Lactnet.  THANKS for anything you can share!

Pamela, Zim