Brief Answer:
Minimum handling and maximum care to the tissues

Detailed Answer:
Dear XXXX,

I have gone through your brief history and have got the gist of it.

Nipple suction device works by creating a negative pressure inside by which the nipples or breast secretions are sucked in it. If the negative pressure is too much or remains for unduly longer time, the tissues get trapped inside the device and their blood supply gets occluded. Thank god, you removed the device before irreversible damage has taken place. There was a risk of gangrene with unduly prolong continuation of the device.

Since you had breast reduction surgery two and half months ago, the tissues of your breast have not completely returned to the absolute physiological state, they are in healing phase. In such a phase, they have been insulted.

The breast is red and swollen with injury to nipple indicates that the tissues are hurt. Fortunately, as of now since there is no fever, there does not seem to be indication of any infection. They need good nursing care.

Please let me know certain details:

1. You had applied the suction device to the breast - was it to suck out the milk in the breast or was it to pull the retracted nipple out?
2. You had undergone breast reduction surgery two and half months ago - was it during pregnancy or while you were suckling the child?
3. Or was the indication for suction device something different - related to the surgery? Do you feel any tenderness under the nipple with some clot underneath?
4. Is there any throbbing pain in the breast now? If so, where?
5. After hot fomentation, the redness goes away - what about the pain? - does it increase, decrease or no effect?
6. Is skin at any place of the injured area becoming purplish?
7. Can you upload the photographs of the damaged breast. As far as possible have image of complete breast and then close ups in different angles.

I feel, if the hot fomentation is only for redness and is not giving you any relief from pain, you should hold it on till you report to your surgeon and get his advice. Hot fomentation may hinder the tissue healing. May be you may get suggestion to apply cold packs rather than hot fomentation. However, that depends upon whether oedema is with affection of blood supply to the nipple or only trauma. For only trauma, cold packs will work better and give you relief. However, this decision has to be taken only after assessing the blood supply to the damaged tissue.

Currently, applying some smoothening cream will give you relief. Even if you apply butter, buttermilk or milk cream, it will soothen the sore tissue. In order to prevent any infection, you may use antibiotics ointment.

Please do not handle the tissue or the breast, use no tight underclothes and leave the breasts free. Wear soft cotton clothes only. No irritation to the sore tissues please.

After viewing the images and getting some more history, I shall be in a position to give you some more advice.

I do understand this condition is quite uncomfortable XXXX, I shall try to guide you out of this.

I am awaiting the information and the images. I am always available for you XXXX.

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Brief Answer:
Continue with cold compressions

Detailed Answer:
Dear XXXX,

I have received the answers of my questions and hope they will help me in guiding you further. However, some answers are rather vague or confusing. I did not understand why you had to undergo breast reduction surgery and why the suction device had to be applied after surgery. Can you please elaborate on these queries?

It is a good sign that there is no purplish discolouration on the breast which reveals that there is no development of gangrene. Please understand XXXX, application of such suction devices for prolonged time always carries the risk of occlusion of blood supply leading to gangrene. You have been saved from it.

Also the absence of throbbing suggests that there is no infection. Another good sign.

So it seems only to be the traumatic insult to the delicate breast tissues. I feel cold compressions might give you some relief. You may have them many times a day, particularly whenever you are uncomfortable. I would have appreciated had you informed me how you felt after cold compressions. Will you please inform me?

You need not apply Neosporine cream so many times. Now it is only for preventing any infection. So just morning and evening application over the affected area should suffice.

It was indeed disheartening to note that you had technical problem in uploading the images of affected organ and lesion. It would have definitely helped me to arrive at some diagnostic conclusion. Please try it again if you don't mind.

Since you have undergone breast reduction surgery, I would like to know whether hanging breast is causing more discomfort to the affected breast, sort of fullness or so. If so, you may have to support that breast without causing any irritation to the lesion.

With the available information and the history you have provided, I feel cold compression should give you relief; however, consulting your surgeon is the best option, how so ever stupid you may feel. I am cent per cent sure, no rational human doctor will ridicule you for whatever accident has happened. What you experienced about me? Did I ridicule you? :)

I am awaiting for some more information that I have requested for. That is going to help me to clinch a fairly correct diagnosis and advise you further.

Meanwhile, please continue with the cold compressions.

For any more explanation or advice, I am always there for you XXXX.

Would you mind posting review about me and rating with five starts if you are satisfied with my advises and approach?

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Brief Answer:
I am sorry

Detailed Answer:
I am sorry to read your impression. However, I honour it!

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