I received a call from a mother tonight who has a history of breast pain and disfuntion during breastfeeding. She has breastfed 3 children ages 11,3 and 1. The baby is still nursing. With each pregnancy, she was initially engorged in both breasts, but totally stopped making milk in her left breast at 4 weeks. With her first baby she was so lopsided and self concious that she weaned at 7 weeks. With baby 2 she pumped for several months trying to keep up production on that side. She had mastitis twice during that time. She ended up nursing on one side only for 14 months. With this thrid baby, she was fine for 4 weeks and lost her milk again, switched to one side and didn't worry. Baby is big, 30 pounds at a year. However, that breast has been very tender to the touch. She is in an HMO and has been seen by 2 OBs, they don't feel anything and have dismissed her concerns. They are unwilling to do an ultrasound and say she is too young for a mammogram (33). She says she "comes off the table" from the pain when she is examined. She can still express some milk from that side and says it is very thick and oily. She has not nursed on that side in over a year. I suggested she go outside her HMO and pay for a second opinion. She is concerned and feels that the pain means "something is wrong". In talking with her, she reported pumping to try and relieve the pain (if due to a plug), massage, touching it a lot. I wonder if she is not keeping up some sort of inflammation in her attempts to make it better? She also reported being sexually abused at age 13 and reported that the man touched her left breast and she has wondered if there is not some sort of psychological basis for her problems. Does anyone have any ideas or suggestions for her? Thanks, Cathy Liles