Barbara, you wrote:

<She
describes a generalized feeling of "burning, sharp-twinges, pins and
needles
" after BF on one side only.><She
says it happens after every BF, on the left breast only, as "the breast
refills." >

I am not clear what is being described, nor, I think, is the mom. Does
the first sentence mean that she breastfeeds on one side only, or that
one side only has these sensations after she breastfeeds on both sides?

In the second sentence <it happens after every BF, on the left breast
only,> does this mean that she feels it only on the left breast, but on
every breastfeeding where she has used both sides, or does she mean it
happens only on those breastfeedings where she only uses the left breast?

I would think it would be important to clarify 1) whether she ordinarily
uses both breasts at every feeding, or alternates breasts at every other
feeding, or what other pattern is happening etc. 2) Could it be she
always starts on the left side, even though using both breasts at every
feeding? If so, without realizing it, she could have created an
oversupply in the one she starts on, and the sensations she feels could
be caused by overdistended ducts.

< as "the breast
refills."> is the phrase that makes me suspect the latter. This sounds as
if what she is really describing is what she experiences at the first few
MER's on the left breast between feedings.

She is interpreting this to be "after a feeding", whereas it might
actually be nature propelling milk forward before what it senses should
be the "next feeding".

The breast "refills" drop by drop as the droplets are secreted gradually,
at intervals across some of the thousands of individual milk cells'
membranes' into the alveolar lumen(s), which become "filled" at
individual times depending on their lining cells' rate of production.

Not all active cells are producing at the same stage or speed at the same
time, therefore, not all alveoli are "full" at the same time.

When a MER happens, it is not only the basket shaped myoepithelial cell
structures around the individual alveoli that contract, moving milk out
of the lumen(s) through the initial tiny ductules, but there are also
contractions of the myoepithelial cells that are arranged longitudinally
and spirally around the larger collecting ducts.

This causes the ducts to undergo waves of contraction that cause them to
both SHORTEN and OPEN WIDER simultaneously to contain the milk that has
been transferred from the alveoli and propel it forward into the larger
and larger ducts in the breast. (Visualize when you put on hose-they
shorten and widen simultaneouly to contain the incoming limbs.)

I think this must be what she is referring to as "filling". When a
particular breast has been primed by the nursing pattern to overproduce,
overdistention of the ducts may be causing some of these sensations.

The sensations might perhaps be from inside the perhaps inflamed ducts as
they overdistend, or the sensation may be on the outside of the ducts,
from the myeoepithelial cells themselves that are spread wider around the
overdistended ducts and struggling to contract around them.

I think some detective work is in order to straighten out precisely what
pattern she is nursing in, before you can get a picture of whether or not
some of my observations above apply.

All of this could be happening without any infective process from any
type of organism at all. Perhaps adjustment of the nursing pattern to
balance out the supply is a place to begin. Keep us posted on how it
works out.

Jean
****************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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