Thanks Barbara for giving such a full description of mammary duct ectasia,
and for your throughts on how to manage this one.  Mother advises that there
was NO secretion from the nipples prior to the first surgery, or even during
the mastitis which came bilaterally after the surgery.  There were three
lots of surgery in a month.  I'm wondering if the surgery itself could have
increased prolactin levels, thereby leading to milk secretion, thence to
mastitis.  It's a puzzle.  Once again, thanks for coming through, and being
so helpful!

So far so good for this mother.  Left breast is lactating a little, mother
is pumping more often than every 2 hours and obtaining 10ml each time, which
is fed to the baby.  Right breast was soft and comfortable yesterday, fuller
today (late lactogenesis in this breast because of no drainage up to now?)
No amount of pumping will produce any secretion at all - I fear the scarring
across the nipple may mean that no nipple pores are patent.  So far there is
no inflammation and no fever.  I've recommended cabbage for right breast -
warmth, massage and drainage for the left breast, continue Augmentin, and
will follow up again tomorrow.  I know that bromocriptine is no longer
registered in the US for suppressing puerperal lactation, wonder what you
use instead.  Here it IS registered for this purpose, and I anticipate that
the gynae may use it in this case if he thinks lactation needs to be
suppressed because of the inability of the right breast to drain.  Will
mention your concern about elevated prolactin levels to the gynae, I suppose
bromocriptine would "fix" this too.

The baby is very happy on lots of formula and the little EBM he gets.  He's
now producing soaking nappies, but the hospital discharge weight showed he
lost 14% of his birthweight before mum commenced supplementing when she got
home.  Mother now tells me that this baby was a "mistake", but she's
enjoying him so much, if they were all as easy as this one, she'd have six!
I can't fault this!!

Pamela, Zim