Permission to post....

I have a 2nd time mother, who has inverted nipples that partially evert with compression of the areola.  Mom reports that her nipples did not invert until after she started breastfeeding her first child, and then they inverted and became very tender with bleeding....she did not have much lactation assistance at that time, but was eventually able to breastfeed and have a full milk supply.  Now, with her 2nd child, she breastfed twice on day one, and had stage 2 damage on the face of her nipples, and decided to do breast rest for part of the day and pump at a comfortable setting.  She has very elastic breast tissue, so she needed a sm. flange insert to prevent her areola from getting pulled too far into the flange tube.  I instructed her on positioning for a good latch.  That night, she tried breast feeding several times, and was then so sore by the next morning ( I got her an Rx for APNO, but they didn't get it filled), that she decided she could neither pump or breastfeed until after she got home--possibly the next day.  I encouraged her to get the APNO as SOON as possible!  The area just proximal to the nipple was extremely tender, and the face of her nipples looked about the same.  The thought of hand expressing was unbearable to her, as well.

I had one other woman who had very inverted nipples, who complained of discomfort in the distal one third of her breasts after breastfeeding for a day and a half.  I'm wondering--might these woman have adhesions or scaring of the tissue at the base of the nipple, that gets "torn" when their newborn starts to  breastfeed, thus causing a lot of pain?  

The infants did not have signs of tongue tie.  Does anyone have information or suggestions about this type of problem?

Thank you ladies,
Kathleen Gale RN, IBCLC, RLC

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