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Discussion Starter · #1 ·
On Friday, I had an excisional biopsy of a suspicious breast lump. The surgeon recommended the excision over the core needle biopsy, and my partner and I decided to go with that. Now, I seriously regret it. I have milk spilling into the breast and leaking out a small hole at the bottom of the incision. Of course, it's better that the incision lets out the milk than keeping it in the breast and letting it fester, but it's still horribly frustrating and annoying.<br><br>
My daughter is 5.5 months old. I want to continue to nurse for at least two more years, and I need some support and encouragement. I definitely won't wean before 12 months, but I'm afraid I'll give up on nursing after that. <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/gloomy.gif" style="border:0px solid;" title="Gloomy">:<br><br>
Any advice? Any thoughts on where to go to find other moms who are nursing with a fistula?
 

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I have never had this problem but I found this:<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Incision and Drainage<br>
This is also a simple operation. Surgeons are familiar with incising and draining abscesses. Breast abscesses need just a little more care afterwards. If the surgeon tells you that there's a risk of milk fistula and you'll have to stop breast feeding beware! You want the surgeon to make a milk fistula. A milk fistula is where milk keeps leaking out of a hole in the breast. If the milk doesn't leak out it will just pool inside making a big milk bubble that will You can keep breastfeeding. You might even consider going to another surgeon - preferrably one who specialises in breasts.<br><br>
The operation goes something like this:<br><br>
A general anaesthetic should be administered with special care that no drugs will be used that may cross the breast milk and affect the baby.<br>
An incision should be made avoiding the areola, preferably set back a little to allow breastfeeding while the wound heals.<br>
The wound should be thoroughly swabbed and flushed out to get rid of all the infection.<br>
A small tubular drain, like a yates drain or a penrose drain, should be put in during the operation.<br>
The tubular drain should be replaced by a nurse with saline gauze wick after the general anaesthetic has worn off.<br>
Not all surgeons know about this, so its a good idea to talk it through first.<br><br><br>
The key thing is to let the wound drain for a few weeks after the operation. The wound needs to be packed with gauze, not seaweed sticks. The difference with breast abscesses is that there's milk leaking into the cavity all the time. Eventually these ducts will stop producing milk but until then you need to keep the milk flowing out of the breast. If the wound isn't packed the skin will heal and the cavity will keep filling up with milk, making it swollen like it was before the operation.<br><br>
Aside: A cavity filled with milk is known as a galactocoele. It isn't dangerous so much as inconvenient. If it gets big enough it will make breastfeeding difficult. Aspiration can ease the discomfort. But back to the topic.<br><br>
While the wound is healing you can expect milk to flow out of the wound at each feed. The milk keeps the wound wonderfully clean and promotes healing too. You can keep a pad over the wound to soak up the milk, but remember to keep changing it after every feed to prevent infection, just like you would with a regular nursing pad. Each day the packing will need to be changed, each time a little less will be put in. Hopefully you'll have a nurse to visit you every day to change the dressing, otherwise it means a trip to the doctor every day. I did get my husband to have a go towards the end when the gauze ribbon would fall out because it was so short, and he did a good job.<br><br>
Hopefully within a fortnight or so the wound will stop leaking milk and will have become so small that the packing keeps falling out. Congratulations! You've weathered the storm and now you're slightly scarred but still breastfeeding.</td>
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It is about an abcess but it speaks to fistulas.
 

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<div>Originally Posted by <strong>NameThatMama</strong></div>
<div style="font-style:italic;">Thank you! Can you tell me where you found that?</div>
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Oh yeah:<a href="http://www.hermes.net.au/pvb/mastitis.html" target="_blank">http://www.hermes.net.au/pvb/mastitis.html</a>
 

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Hi! I had a breast abscess drained about two weeks ago & in addition to the milk leaking out of the incision site, I've also developed fistulas where the abscess ruptured through the skin on its own. I've looked everywhere on the Internet re: milk fistulas, but there is so little out there about people's experiences w/ it, esp. w/ nursing. My baby is only 6 weeks old & I had planned to nurse at least a year!!! My surgeon had suggested weaning since I still had pus pockets that were forming & I also have milk collections underneath the skin where the abscess was (bad healing).<br><br>
I've also tried feeding on the non-fistula breast only (read your other post) & found that I was able to produce enough from one side. However, I probably leaked just as much so I'm not sure if it's 'worth' it to nurse one-sided if the fistula is just going to pour out milk anyway (plus, I don't want to get plugged up & get another infection!!). Have you found that it's helped close the fistula by nursing on one side?<br><br>
You can PM me if you want. I would love to hear from someone w/ this same problem!!<br><br>
Val
 

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Discussion Starter · #6 ·
Hi Val! Here's my story:<br><br>
Biopsy was performed 7/21. Leaking noted within a day. I used Lansinoh disposable pads to collect the milk, and I was going through 2-3 a day. On 7/31, I returned to the surgeon for a follow-up, and he taught me to apply a pressure dressing on the basis that keeping the pressure in the ducts low would allow the incision to close up and heal. He also recommended a breast binder, which I was not able to find, nor was I convinced it was a good thing to use anyway.<br><br>
I spoke with a LC who recommended that I nurse more on the fistula side to keep the pressure low. After a week of doing that, I went from leaking out of one part of the incision to leaking out of THREE. I emailed Jack Newman for advice, and he said to wean off the fistula side. I was really disappointed because I felt like emailing him was the magic bullet, and it was the last thing I wanted to do. However, I had a terrible allergic reaction to the surgical tape, so I was pleased to stop doing the pressure dressing.<br><br>
It took about a week for my supply to adjust enough that I could get away with only nursing a couple of times a day on the fistula side. (We nurse at least every two hours when we're together--I work out of the home four days a week--so twice a day on the fistula side really isn't much.) Within the next week, the leaking had stopped. Two days later, I saw a wound specialist who said that it was healing nicely and would be fully knit together all the way through within a month. We just hit the 30-day mark, and yesterday, I started to nurse her again as much as possible on that side.<br><br>
Things of note:<br><br>
* I am currently lopsided. It's an aesthetic thing, but it's noticeable to me and to my partner. I used a breast pad on the fistula side even after I wasn't often leaking because it gave me a little extra boob girth. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/orngtongue.gif" style="border:0px solid;" title="Stick Out Tongue"><br><br>
* I had a lot of trouble pumping enough milk for her when I was away from her. I started a rigorous pumping routine (which I can say more about if anyone is interested) and pumped from the fistula side once a day and nursed on that side once a day.<br><br>
* For whatever reason, nursing on the fistula side made her a little spitty in the last week or so. The milk pumped from that side did not, but it was always mixed with non-fistula-side milk.<br><br>
* I work for a large medical system, and I do patient research. I am very skilled at navigating a medical system, and I really feel like my case was mismanaged, even when I advocated for myself so strongly. It's very easy to get lost, but you don't have to. You can stand up for yourself and get the care you need. If they won't give it to you, you *can* take matters into your own hands. Let me know if I can help in any way.<br><br>
Best,<br>
emilin
 

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NameThatMama, glad that you've gotten some good replies. I had an abcess, so the incision and drainage is my own personal experience. Just wanted to point out that an I&D is a bit different probably from the procedure that you had, in that abscess incisions are left open, to heal from the inside out.<br><br>
If its helpful (even just to be steamed over doctors!), here's my story:<br><br><a href="http://www.kellymom.com/bf/concerns/mom/breast-abscess.html" target="_blank">http://www.kellymom.com/bf/concerns/...t-abscess.html</a>
 

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Thanks NamethatMama & Fiercemama for your replies. Unfortunately for me, I have the worst of both experiences......a fine needle aspiration to rule out breast cancer, followed by an abscess that needed to be I & D'd.<br><br>
It's been so frustrating knowing what to do since the info is conflicting...okay to BF after abscess, not okay to BF with a milk fistula. What's a girl to do when she has both???!? Anyway, I'm thinking about trying the route of weaning on the fistula side, rather than a complete wean. I too found out that nursing on that side just made the fistulas open up more. Hopefully, a partial wean will be the compromise!<br><br>
Thanks,<br>
Val
 

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Why is it not ok to nurse with a milk fistula? I have heard mums who've had this information from their health care providers again and again. You can't have an I&D and NOT have a fistula. It may mean that your incision will heal more slowly, but the wound will be kept clean, and you have less risk of further plugged ducts/mastitis/abscesses.
 

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Discussion Starter · #10 ·
I, too, am confused about why you can't nurse with a fistula. It might not go away until you're done breastfeeding (although I believe this is unusual if you're willing to wean off that side), but it's still possible.<br><br>
The other thing that I remembered that's worth knowing is that you're probably going to be nursing more than twice as much on the non-fistula side. You may have a significant amount of nipple soreness (although your kiddo isn't likely to be cutting teeth around the single-sided time like mine was). It's okay to use a pacifier if your kid isn't hungry and wants to suck. You have to protect your nipple in order to maintain your breastfeeding relationship. Obviously, it's best if your baby sucks often so that your supply is constantly stimulated, but be sure to protect your nipple from getting too battered. For about a week, mine hurt so much that I couldn't sleep while she nursed.
 

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I guess the surgeon wanted me to wean since the area is not healing too well. Honestly, I think the area needs to be drained again 'cause I see milk (if not pus) still collecting underneath.<br><br>
Anyway, I have basically continued nursing, but boy!...it is hard to nurse mainly on one side!!! The soreness! But, it's been getting better.<br><br>
Val
 

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<div style="margin:20px;margin-top:5px;">
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<div>Originally Posted by <strong>vwh99</strong> <a href="/community/forum/post/6085511"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Thanks NamethatMama & Fiercemama for your replies. Unfortunately for me, I have the worst of both experiences......a fine needle aspiration to rule out breast cancer, followed by an abscess that needed to be I & D'd.<br><br>
It's been so frustrating knowing what to do since the info is conflicting...okay to BF after abscess, not okay to BF with a milk fistula. What's a girl to do when she has both???!? Anyway, I'm thinking about trying the route of weaning on the fistula side, rather than a complete wean. I too found out that nursing on that side just made the fistulas open up more. Hopefully, a partial wean will be the compromise!<br><br>
Thanks,<br>
Val</div>
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I had a core needle biopsy to rule out cancer when dd was 4 mo old. I was told not to nurse on that side by my surgeon. I also got an abscess (breast infection) in that area post biopsy that needed to be drained several times. When he found out that I was still nursing on that side that had the infection he basically told me I was poisioning my daughter. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"> Thank goodness I was in contact with a LLL leader during this whole time and she had documentation that showed it was safe to nurse with an abscess. I don't know about fistulas though. Have you contacted your local LLL?
 

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Discussion Starter · #13 ·
Val, I worked with my LLL leaders, and the best they could was through Melissa Vickers, a Leader at the divisional level, who referred me to a case in which a mom fed almost exclusively off the non-fistula side, and her fistula healed. That's basically what Jack Newman said to do, and it's what I did, and it seems to have worked well enough.<br><br>
But I did *not* have an abscess or infection.<br><br>
Here are some thoughts:<br>
* Consider seeing a wound specialist to help with the care and dressing of your wound. They're usually nurse practioners, but they're sometimes plastics specialists. It would be an office visit, but they might be able to help you keep things healthy from the outside.<br>
* Use a pacifier when your kiddo needs non-nutritive sucking and your nipple is worn out.<br>
* Nurse periodically on the fistula side to keep the milk flowing enough to reduce the risk of (continued) infection.<br><br>
The wound should stay as dry as possible so that it doesn't erode. I was able to do that with disposable breast pads, even though we're a cloth diaper/mamapad family through and through. Lansinoh pads are the best for that, IME.<br><br>
You *can* get through this. Keep us posted.
 

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Your story sounds like mine. Thanks for the encouragement everyone.<br><br>
Yesterday I had been feeling good about having weathered the most of it....the breast cancer scare, the abscess, the I&D and more importantly, the disapproving looks and comments about 'poisoning my child'. I even felt strong enough that I could endure another I & D to drain out the remaining pus that's been a problem for me since the last surgery.<br><br>
So, wouldn't you know it? I woke up with a high fever and chills today (first time in 2 months!) and now the surgeon wants to operate today. I think this may be the last straw.........I'm so sad. (though I'm still entertaining the notion that even if I let myself dry up so that my body has a chance to recover as I'm SO tired, then maybe I can try relactating later?)
 

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Discussion Starter · #15 ·
I'm so sorry. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"><br><br>
Breastfeeding your child is the best thing you can do under normal circumstances. These circumstances are *not* normal. It's not good to have an open wound and be on antibiotics often or for a long period of time. It *might* be best to let your breasts dry up and heal and relactate later, and if that's the case, you're doing the best thing for your child.<br><br>
Can you get a second opinion? Have you emailed Jack Newman to see what he thinks? Before you wean, try that.<br><br>
Also, talk to your LLL folks and at least one LC. If cost is an issue (it would be for me, I know), remember that you'll be saving $20/week if you're able to keep breastfeeding and don't need to switch to formula.
 
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