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Thread: advice? help? support? milk fistula.

  1. #1
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    Default advice? help? support? milk fistula.

    I don't know if I'm looking for advice or just a there-there. I posted earlier about my breast biopsy. The lab results there are all-clear, absolutely benign, I'm happy to say.

    But the physical result is less nice. I developed a pretty bad infection, painful and ugly. I was put on two simultaneous antibiotics after spending a whole day in different doctors offices (my wonderful ob/gyn, a surgeon, a sonogrammer). Now that the swelling has gone down a little, I am leaking milk from the biopsy site. A lot. Soaking through pads. I'm going back to the surgeon (NOT the guy who did the biopsy, who I saw this morning) tomorrow, but in the meantime it does not take much for me to realize that I have a milk fistula. I am not feeding my LO from that side because of the impossibility of keeping the breast clean--it's not just milk leaking--just pumping.

    I am very frustrated. I hate that my LO is getting antibiotics in his milk, that I'm uncertain about the milk in the affected breast, that I can't cuddle my LO as usual because I'm so sore. And from what I'm reading on the net, it looks as though I may be advised to supress lactation in the affected breast.

    Any advice? Anybody with any experience?

  2. #2
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    Default Re: advice? help? support? milk fistula.

    I don't have any experience with this but I'm so sorry this is happening to you.
    Jackie


    "Breastfeeding is an unsentimental metaphor for how love works, in a way. You don't decide how much and how deeply to love--you respond to the beloved, and give with joy exactly as much as they want."
    ~ Marni Jackson"

  3. #3
    jaamommy is offline Shares Widely And Frequently
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    Default Re: advice? help? support? milk fistula.

    Do you have a local LLL leader that you could contact for more help on this problem? I hope you find the help and advise that you need mama!

  4. #4
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    Default Re: advice? help? support? milk fistula.

    Hi Lou Lou. I know it's probably too late to give you advice you can act on, but I'm posting because I'm sure there are other women out there looking for info. I had a core biopsy last week and knew (from reading online) that it could result in a milk fistula. I lost some fluid from the incision point the first day (blood with some clear fluid and milk), but the fluid largely dried up within one day. On day 4, I started leaking milk tinged with blood. Now it's just milk pretty much. I, too, am soaking nursing pads.

    I first called the breast cancer center yesterday where I had my biopsy taken. The nurse there said it was probably okay to continue to breastfeed but I should check with my OB-GYN. I then called my OB-GYN, and she said it's okay to continue breastfeeding. I wanted to find out how long this fistule would remain, so I did some online research. I've read conflicting things about healing and breastfeeding, so I used my university library to search for journal articles. I also called my lactation consultant (who said to nurse but have my OB look at it just in case). It may last as long as I continue to nurse, but it might heal sooner.

    I came up with a couple of case studies, and I could only access one immediately. Being a case study, it's only one pair of doctors' opinions, and the article was written over 10 years ago:

    "A milk fistula is more an annoyance than a threat. It disrupts the patient's lifestyle and could delay her return to work. A fistual can dry up spontaneously while lactation continues, but this result is not certain and closure can take several weeks [1,2]. The only reliable means of stopping a milk leak is for the woman to suppress lactation. The combination of breast binding and lack of sucking stimuli causes lactation to cease in about 1 week, but the patient may be uncomfortable because of breast engorgement [8]. Bromocriptine [...] suppresses milk production within days without discomfort. Treatment must continue for 2 weeks to prevent relapse." from Schackmuth EM; Harlow CL; Norton LW. Milk fistula: a complication after core breast biopsy. AJR. American Journal Of Roentgenology [AJR Am J Roentgenol] 1993 Nov; Vol. 161 (5), pp. 961-2.

    I also did a general Google search and a search using Google Book and found some advice that said a woman can and should keep nursing. Here's an example:

    If you search Google Book, click on About this book (some current books are available, but many materials are from the late 1800s).

    In addition, I found this discussion, which includes the experiences of several women: http://www.mothering.com/discussions.../t-489632.html

    Ultimately, I'm going with my lactation consultant and OB-GYN's advice. If I run into problems, I'll seek further advice.

  5. #5
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    Default Re: advice? help? support? milk fistula.

    Thanks, Susan--and I'm sorry you had to go through this, too. If I knew then what I know now, I would have waited (the mass they were biopsying looked cystic from the ultrasound; I had a cyst in a similar spot years ago; I have no family history; of course it depends on the woman and her doctor). For me it was as though the radiologist had NO IDEA that biopsying a lactating woman was different. But I did keep nursing without a problem (I took a break when it looked really infected) and my LO did not seem to mind at all.

    I am just getting over the serious antibiotics I was put on to fight the infection, which it turned out I was allergic to--talk about adding insult to injury (or itch to infection).

    I hope you're on the mend soon and that your results are good!

  6. #6
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    Default Re: advice? help? support? milk fistula.

    Thanks for the good wishes. My results came back negative for cancer!

    Susan

  7. #7
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    Default Re: advice? help? support? milk fistula.

    Okay, I ordered a more recent article on fistulas, and it just came in:

    Friedman, Paul, and Linda Sanders. "Milk Fistula: A Conservative Approach to Treatment after Core Breast Biopsy." Journal of Women's Imaging 5:1 (2003): 40-42.

    Friedman and Sanders report on the case of a 33-year-old postpartum patient (2 weeks after delivery) who had a core biopsy and subsequently developed a milk fistula. The mother wanted to continue breastfeeding. They note that the standard treatment for a milk fistula is "to interrupt breast feeding and/or administer bromocriptine, a dopamine agonist intended to inhibit milk production" (41), but recognize that there are a number of other treatments, including managing the milk by "drain[ing] into an attached colostomy" (41) and correcting it surgically.

    They chose to have the woman consistently apply "gentle but firm pressure over the leakage site with a gauze pad [...] during all breast feeding and to accelerate feeding from the right breast" (41), which was the breast with the fistula. Even though the extra nursing on one site would tend to increase milk production on that side, they believed that it kept the pressure of the milk low, allowing the milk to be "diverted from the peripheral fistula and to the more steady stream of breast milk coursing out of the centrally located ducts at the nipple" (41) and allowing the fistula to heal in 3 days.

    Back to my own experiences: My Steri-Strip looked terrible after 10 days. I could tell it was a bacteria factory, so I took it off ahead of time. It wasn't doing any good anyway: the constant wetness had caused most of it to come off, and it was no longer taut, so it no longer held the incision together. Not having any Steri-Strips at home, I replaced it with a piece of 3M medical tape that I cut to mimic the Steri-Strip. I applied the tape so it dimpled my breast just a bit, just like the nurse applied the Steri-Strip. In other words, I applied it so it held the incision closed tightly.

    I pretty much had no flow from the fistule all that day, so I didn't wear a nursing pad to bed. Mistake. My daughter slept longer than usual, and my breast became engorged, causing milk to rapidly leak from the fistule. Even before reading Friedman and Sanders's case study, I started nursing her more on my affected side to reduce the pressure from milk, and it has helped. I'm now going to apply a bit of pressure while breastfeeding too to see if it will heal completely.

    If anyone else out there is reading this, please note that the authors point out that breast cancer in lactating women, although rare, is serious, and they recommend having a biopsy if there is a question of cancer. They say that "it is believed that carcinomas in these women [lactating women] disseminate rapidly and have a generally poor prognosis, necessitating pathologic correction" (they cite a 1993 article by R.K. Gupta and A.G.R. McHutchison).

    Susan
    Last edited by SusanTX; October 16th, 2007 at 12:27 PM.

  8. #8
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    Default Re: advice? help? support? milk fistula.

    & I will add--that all looks like great information, and you are VERY smart to be careful about infection. As my radiologist told me after infection had set in, "milk is a culture medium." It's bad enough to be unsure about nursing without a sore breast--though once I got the go-ahead from my ob/gyn to nurse, breastfeeding definitely helped with the pressure.

    And I'm glad your biopsy results were good!

  9. #9
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    Default Re: advice? help? support? milk fistula.

    Hi Lou Lou.

    It turns out that I should have acted sooner to prevent infection. I just developed one with an abscess, and it is yucky! I'm on breastfeeding-safe antibiotics, though. I started a new thread to ask about my baby's diapers and if the smell is related to my infection (http://forums.lalecheleague.org/show...54#post320754). Will the fun never stop?

    Susan

  10. #10
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    Default Re: advice? help? support? milk fistula.

    The fistula has healed! Once the pressure from the infection was gone (a couple of days on antibiotics) and I kept the pressure from milk low, it healed. I applied some pressure with my hand to the fistula while she nursed as well. I hope others have success healing too.

    Susan

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