Over a month ago I asked for help for a mom who had a pea-sized white lump on the end of her nipple. She had flu like symptoms which her OB/GYN treated with two sessions of antibiotics. It kept reappearing with pain while nursing and a feeling of general malaise for her. She was referred to a surgeon who lanced the end of the nipple (no anesthetic!!), extracted what he called a "nipple thingy" (stringy substance typical of plugged duct) and sent her home. The surgeon was not BF friendly, evidently had no experience with this type of problem, and was not very supportive. The problem has not gone away. It is painful, and today's temperature in NH is over 90 degrees, and the mother feels she is at her wits end. We have tried quite a few things such as rest (she has 5 children 7 yo and under), different bras, sleeping on the other side, more attention to diet, and analgesics. My feeling is that this problem is at the end of the nipple, not the duct blockage that I am familiar with. I have been reading in Lawrence about a duct ectasia or so-called comedomastitis. She says it is "an inflammation of the terminal duct. An irritating lipid forms in the ducts producing an inflammatory reaction and nipple discharge.. Cytology shows debris and epithelial cells. Duct ectasia may be associated with burning pain, itching, and sweling of the nipple and aerola. Palpation reveals a wormlike tubular feeling once called varicocele tumor of the breast.. As the ds progresses , a mass may develop that mimics cancer, and chronic inflammation leads to fibrosis. Surgery is not indicated unless the discharge becomes bloody. The ds is usually treated with thorough cleansing with pHisoHex or povidone-iodine (Betadine) daily and avoidance of nipple manipulation. Lactation would aggravate preexisting ds but would not be an absolute contraindication." Could this be what this mother has?? I have suggested to her that worst case scenario would be that she taper off nursing on that side and continue to nurse her very healthy and happy baby on the other side only. I have seen this nipple and it does not look particularly alarming. The nipple hole appears yellow compared to the other nipple holes, and she says she can scrape off the top with her fingernail or a pin when it gets sore and she can feel the plug way back under her arm. She and I are concerned about an infection due to this almost weekly processs of invading the nipple integrity. It is painful, and she feels mastitis type flu symptoms whenever it flairs up. Help us if you can! Michelle Scott, RD,MA,IBCLC in NH. Below is her own history of this problem. Email me directly with your comments or CC them to me as I am up to my ears in work. MOTHER'S STORY Thanks for your continued help with my breastfeeding concerns. I really appreciate all you have already done to help me. I'll try to come up with a detailed description for you. Here goes: approx. May 5 - 15 Began with body aches and shooting abdominal pain in the lower right pelvic area (when changing nursing positions, etc.) (intermittently for two days), right ear ache and right breast achiness. Was put on Amoxicillin 500 mg for seven days for possible ear infection. Pain focused to the right breast in a few days. Stabbing pain between nursings of about a seven on a scale of 10 (10 being the highest). Sharp, pinching pain when the baby nursed. (felt like she had a mouth full of teeth). The breast pain continued throughout the whole course of antibiotics and then 4 -5 days after the antibiotics were finished, there formed a small white lump on the right nipple, very small, looked like a white head (but under layers of skin). Trouble expressing milk from that breast. Began treating for a clogged duct. approx May 19 - 26 The lump had grown in the last few days to about 4 times the size. It appeared to be the size of a pea, hard and white under the skin, sticking out halfway, right on the right nipple. The doctor thought the baby bit me and it got infected. He prescribed another antibiotic (Dicloxicillin 500 mg) for seven days and wanted to see me in a week. Pain persisting, both when nursing and when not nursing. Painful to the touch. Definite blockage of milk ducts...when hand expressing, it was obvious that only about two to three ducts were able to empty. May 26 - pain unbearable, went in for a re-check. The doctor thought it looked better. I thought it had not changed at all (or had gotten a little bigger). Doctor and nurse now checked to see if it was a breast abcess--determined it was not...they thought it was a blood clot that had formed...said it would just reabsorb into my body...referred me to a breast specialist since they weren't sure what it was. June 2 - appointment with breast specialist...he laughed at what the O.B. thought it was. Said it was a cyst formed from a clogged Montgomery Gland that had to be removed because it was obviously (on ultrasound) blocking several dialated milk ducts that were unable to drain. He said he had heard of clogged ducts but had never seen one before. Prescribed EMLA cream to be applied two hours before the surgery. Did not want to use anesthesia so as to minimize swelling and to not interfere with the milk ducts. Said I should pump on the affected side one time after surgery and then discard the milk.... then nurse regularly after that. Set an appointment for the following week...OUCH! June 9 - went in for surgery. OOOUCH...needless to say, the EMLA cream was not enough to properly numb this very sensitive area. The lump was, however, removed. The doctor chose not to use stitches (thank God!). Instructed me to pump for 24 hours before feeding baby on affected side. Did as directed...lots of blood in the milk. 24 hours later, the milk looked very normal, so I did begin to nurse baby. Although painful, things seemed to be getting better. June 13 - (seems to be starting all over again) Felt run-down, nauseous, sharp shooting pains on the right breast (beginning at the nipple and going in from there) began slightly, here and there. By this time, the nipple appears to have a 1/4" cut in it which opens to a small indent. Painful to the touch. June 14 - a couple points during the day, pain so sharp I decided to get baby and nurse on that side to hopefully find some relief. Pain lessened a little, but was still present. Went home, took Tylenol and a nap. June 15 - present - Still experiencing pain...sometimes sharp, sometimes mild. But things are just not normal. Hope this helps.....I think this is pretty accurate. Thanks again for all you've done.