I just talked with a who mother had breast reduction surgery in 1987.  When
her first child was born, 2 years ago, breastfeeding quickly became painful.
She pumped, mainly with a mini-electric, for 4 months, getting 1-2 oz *per
breast* each time(!)  Her nipples never entirely healed and weren't
comfortable until she stopped lactating.

Her second child was born 5 weeks ago.  Within a few days, nursing resulted
in damaged nipples and a baby spitting up blood.  She also developed
mastitis, which was treated with 7 days of dicloxacillin.  Back to the pump,
with coagulated milk (gelatinous blobs) produced until she'd been on the
antibiotic for a few days.  She's been using a Classic.  Milk volume has
been well below last time's, but she hasn't been pumping as regularly as
before.

She started APNO early on, but nipple wounds remain - a central fissure on
each nipple.  Milk was cultured at 3 weeks and a second 7 days of
dicloxacillin begun.  The culture revealed small amounts of Staph aureus,
and nothing else.  But every time she puts baby to breast, her nipples start
bleeding and continue for more than a day.

I'll be unavailable (both to her and to you) for a week, but am leaving
larger diameter flanges for her to try, on the chance that she pumped
before, and is pumping now, with too-tight flanges and that that, not some
unusual infection or anatomy, is the underlying problem.  Though her nipples
are slightly smaller than a nickel, she says they swell and turn purple with
pumping.

Do you have other thoughts?  Could the surgery itself be responsible in any
way?  This is a woman who could probably produce at least half her baby's
needs (based on her first lactation), and who is more than willing to use an
SNS.  But she can't get rid of the pain and bleeding.
--
Diane Wiessinger, MS, IBCLC, LLLL  Ithaca, NY
www.wiessinger.baka.com

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