This morning I saw a 3rd time mother with a history of breast surgery 3 years ago for what started out to be an unidentified painless lump. She had weaned her second child one year previously at the age of 3 weeks, and remembers that she had "gallons of milk", but he had cried all the time, so she put him on the bottle. She remembers no problems with the breasts during the weaning period. The lump in the left breast was removed, the contents were found to be sterile, but she remembers the surgeon says it burst as soon as he touched it. Several weeks later she suffered inflammation and pain in both breasts which led to abscess formation and more surgery, on both breasts. Several weeks later it happened again. More surgery on both breasts. So she had three incisions on the left breast and two on the right (scarring 10 - 2 o'clock on both areola, and a horizontal scar right across the right nipple). The areolas are misshapen, flat across the top and indented, not round. The surgeon diagnosed "mammary duct ectasia", and wanted to remove "all the ducts", but she refused. During this time she remembers endless antibiotics and pain, but that any lab tests that were done came back with the results "sterile". She eventually took "garlic and parsley tablets" and everything resolved. One whole year later both breasts flared up again, she took the garlic and parsley again and this was effective. Now she has a 4 day old baby, and thinks she doesn't want to breastfeed eventually, but is open to the idea of getting him off to a good start for the first few weeks, if this will be possible. The left breast is firm, the milk appears to be coming in, the left nipple is deeply abraded because the baby has been breastfeeding often since birth from this breast (covered latching and strategies to minimize further trauma/facilitate healing). Milk transfer from this breast is low. The right breast appears to be making considerably less milk, only one tiny firm area at 12 o'clock and neither she nor anyone else who has tried can express ANY milk from this breast at all. Manual expression by me produced minute drops from openings that appear to be situated on the areola, near the nipple, not the nipple itself, one at 10 o'clock and the other at 5 o'clock. Baby hasn't latched at all from this breast, but we covered how to present breast to baby and he went on and sucked like a dream, appearing to SWALLOW occasionally. The baby is healthy and alert, has been breastfeeding often but lost 10% of his birthweight by yesterday and has had 3 "brick-dust urine" nappies. Mother wants to start supplementing because he seems so hungry and I have to agree. I have covered strategies to DRAIN these breasts as frequently and thoroughly as possible, suggested repeat antibiotic (to make up to 10 days cover instead of 5), suggested cabbage to help with potential engorgement. Given info that if ducts severed and unable to drain then they will eventually involute, if it is possible to drain these breasts then it is imperative that she do this and decide on breastfeeding/weaning later (after 3 weeks). Recommended daily follow-ups until we're sure of what will happen. Liaised with referring gynae who is happy to see mother in the next few days and refer on to (different!) surgeon if necessary. Permission received to share case history with you! I seek your thoughts on the above - anything more I need to look out for - any other strategies to use? And has anyone heard of "mammary duct ectasia". My (old!) medical dictionary defines this as "dilatation of the collecting ducts of the mammary gland, with inspissation of gland secretion and inflammatory changes in the tissues." "Inspissated" is defined as "thickened; made less fluid." In the interests of speed I'd be grateful if replies could be e-mailed to me as well as to Lactnet. THANKS for anything you can share! Pamela, Zim