Hello wise community,
I have permission to post for your feedback. I am a newly practicing IBCLC
in Michigan, USA and a LLL Leader as well as a WIC volunteer. I met with a
mother today who is very distressed over her struggle to maintain supply
especially in the face of a major sudden drop on one side. She has spoken
with several LCs and LLL and no one can quite figure it out. It seems at
first like plugged ducts but is not resolving with the usual treatment.
Here are the details:

33 year old first-time mother 5 weeks, 2 days postpartum (pp). History of
fibrocystic breasts to the degree that an abnormal breast exam resulted in
further testing which revealed very dense breast tissue. Beautiful latch
and normal growth pattern, although mother was concerned about baby being
1oz shy of birth weight at 2 weeks old so began pumping after feedings and
taking fenugreek which she stopped at 5 weeks pp. Started supplementing by
bottle starting at 2 weeks and baby grew 7oz that week. Using approx 1oz
formula daily when pumped milk runs out. Began taking Nifedipine for
vasospasm at 3 weeks pp and discontinued at 5 weeks pp with no further
occurrence. Her lochia stopped at 3 weeks pp then started back again at 5
weeks and now appears heavier like a period. She reports that her breasts
normally became more dense during her periods before pregnancy, but always
on both sides.

Current condition is a large mass of dense tissue on the inside of the left
breast extending from just below the edge of the areola outward in a wedge
shape. It is diffuse, deep, immobile, heavy, and not painful. It is not hot
to the touch nor is it red. Mother reports she woke up 2 days ago to
discover this breast suddenly much larger than normal and firm only in that
area. Attempted breastfeeding and pumping yielded little result. Massage,
heat, cold, husband suckling all resulted in no change. Both breasts are
quite dense throughout.

Is it possible she is experiencing hormonal changes related to early return
of menses which is causing a temporary obstruction of milk flow from the
fibrocystic masses? Perhaps her "plumbing" on the left side is a bit more
complex and therefore this side is more affected than the other? Or maybe
it really is plugged ducts that are presenting differently because of the
density of her breast tissue? Could the ceasing of the fenugreek and
Nifedipine have something to do with it? Maybe since Nifedipine is a
vasodilator it was helping to keep her milk moving?

I observed her pumping and hand expressing 3 hours since the previous
feeding and her breasts appeared quite full with shiny surface skin, but
there was very little flow of milk (no spraying, only drips, about 2.5oz
total). The right side did soften after about 15 minutes of feeding, but
remained very dense which the mother said was normal for her. Baby became
frustrated on the left after about 5 minutes of trying. I noted the mother
uses the football hold about 90% of the time and holds her breast in the
same spot where the dense tissue is now.

This mother is a pediatrician herself and very much wants to breastfeed.
After her c-section due to a too-small pelvis she is feeling defeated and
guilty. She is ready to give up because of the emotional turmoil at this
point. I hope to help her find some answers and get to a happy
breastfeeding place - even if it means "retiring" the left breast
altogether and ramping up her supply on the right to compensate. I am
consulting with a breast disease specialist who will do some imaging
(mammography/ultrasound) and possible aspiration to help get to the bottom
of this. She has started the fenugreek again, started lecithin, and I've
told her about EPO and reducing saturated fats.

Any ideas you might have would be greatly appreciated.

-Keleigh Lee, IBCLC
Ypsilanti, Michigan, USA

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