Do I have to give up breastfeeding?

[TreaterAnita]

After weeks and weeks of problems feeding from my right breast (starting with milk blisters and then progressing to recurrent mastitis and a permanently engorged lobe), as the icing on the cake when I finally got to see the breast surgeon on Tuesday I had developed an abscess for which I'm currently having daily drainage.

The abscess is definitely improving which is a blessed relief (I was literally crying with pain on Monday) but I cannot, despite trying every recommendation I can think of, empty the engorged lobe which is on the top of my breast (and was the reason my GP referred me to the breast surgeon in the first place). It's not especially painful by itself (unless infected) and does just feel like engorged breast, but it's still there even when the rest of the breast is soft. In the last 4 or 5 weeks I've only managed to soften it once, a couple of weeks ago, by hand expressing in the shower, but that took a lot of force and I think may have contributed to the abscess. I think the problem is a blockage in the duct at or near the nipple as I initially expressed a sort of white stringy substance followed by very thick yellowy milk which had a mucousy texture and needed to be wiped off the nipple rather than flowing. Since then I haven't been able to hand express or pump (because of the position of what now turns out to be an abscess) and my baby doesn't appear to be able to shift it.

I was hoping that, once the infection is properly under control, I could stop feeding from the right breast and that the milk trapped in the engorged lobe would reabsorb and the breast would return to normal. However when I mentioned that to the breast surgeon he didn't think that would work, essentially saying that milk production wouldn't stop if I was still feeding from the other side. Today he suggested that if I want to carry on breast feeding I need to be able to fully empty the breast but I've tried and tried today (and for the last month) and it simply isn't going to. I even tried hand expressing (with gritted teeth) and there is no milk coming from the top of the nipple even though I know there is a duct there as that's where I had the milk blisters and also managed to express the gunk from a couple of weeks ago.

My baby is currently 14 weeks old and I really want to BF her at least until 6 months if i can. I'm happy to do this exclusively from the left breast as it's been doing the lion's share of the work for a while now and I have a good supply and can always supplement with a little formula if I have to. However I really want the problems with my right breast to resolve, and I can't go through another day of pain like I did on Monday again. Despite hours of googling I've struggled to find anyone who's had a similar problem (specifically the non-draining lobe) so if anyone has any advice I'd be really grateful.

You need to see a proper lactation consultant asap. Your local hospital may have one, or contact le leche league/nct for a contact. I'm sorry you're having such a hard time with it but feel very proud of how well you are doing.

Thanks for the reply Chiefbumwiper. I went to the breastfeeding group at the hospital today and spoke to a couple of members of the feeding team - they did their best to be helpful but all they could really say was that they knew women who had breastfed from one side only, but that doesn't solve my problem. There is a breastfeeding co-ordinator at the hospital who knows her stuff but from previous experience she's pretty elusive. I'll try contacting LLL/NCT tomorrow.

Sorry you're having all these problems it sounds horrific. Definitely second contacting your local LLL. They have recently helped me with problems that other 'specialists' missed! In meantime keep massaging the area to loosen up the blockage as best you can!

Have you tried hand e pressing in the bath? Apologies if you have, but I found that a good long soak in a very warm bath softened all the skin up on my nipple and allowed me to get all that gunky stuff you describe out. I didn't have an engorged lobe, (and I don't really understand why it works much better than shower but it does for me) but when I had a persistent blocked duct it was the only way I could shift it.

Wow, well done lady what a rough ride you have had. I hope this helps.....

My friend had a really nasty breast abscess that needed draining and was able to feed through it within a couple of days of the pain making it manageable!!!

Towards the back end of feeding my 2nd child, I only fed off one breast. I was more comfortable on the left breast. Occasionally I would offer the right breast but in the end, the breast hadn't been used for a long time and the milk flow was too reduced and there didn't seem to be any milk left. With hindsight I could have increased the supply but we did ok just feeding off the one breast..

The breast surgeon is misinformed. Tell him to look into "feedback inhibitor of lactation" which is the mechanism that the body uses to know when to stop making milk. It works locally, in one breast at a time.

It is not that unusual for women to feed one sided. You can do this if you want.

The engorged lobe may be down to a bleb - kellymom has some good info on blebs, some of which is home care. They also talk about lecithin (which is a dietary supplement) being useful to prevent blebs, if you are prone to them.

NQC is right.

Anita, it is a paradox, but breast surgeons may not know much about the lactating breast.

I have come across a number of situations where women were given entirely erroneous information by a breast surgeon.

I don't think it will be possible for you to fully empty the breast, either. And it's news to me that it is absolutely necessary. The milk remaining in the affected breast does reabsorb - it disappears anyway, somehow :) That's my understanding and the experience of women I have supported through these situatuons.

Yes, one sided feeding is possible.

Just to add: second opinion will help you, plus a further discussion with the surgeon.

Thanks for all the replies, really really helpful (and the sympathy is much appreciated too).

I was pretty sure that the surgeon was wrong as he was explaining it to me, but it was pretty clear that it wasn't up for further discussion...

NQC my gut feeling is that the blockage is in the nipple but I've tried every bit of advice I can find on the internet about how to unblock it and it's just not happening, at least not without me applying a huge amount of pressure on the exact spot where the abscess is.

tiktok I think the surgeon meant that I need to be able to fully empty the breast because otherwise I'm just going to keep getting infections due to the milk stasis, which I'm sure is true. But what I was hoping was that, if I stopped feeding from the affected breast, it would stop producing milk and the blocked milk would then reabsorb so it's good to know that that's what happens in your experience.

Have you supported any women with my specific issue before? My GP's original reason for referring me (pre-abscess) was to check that there was no 'sinister' reason why the lobe wasn't emptying (i.e. a tumour) so I'm still a bit worried about that in the back of my mind, and no-one's looked into that yet as the abscess has somewhat stolen the limelight. I do have medical insurance through work though so I'm going to speak to the GP tomorrow to ask for a private referral I think and hopefully it will be a bit easier to have a 2-way discussion when the doctor's time is billable.