This topic is about managing persistent leaks and skin damage from a high-placed ileostomy, which is located just beneath the breast line. This position makes it difficult to properly see and secure the pouching system, leading to frequent leaks and skin damage. Here are some helpful tips and insights to address these challenges:

1. General Application Tips:
- Ensure the skin around the stoma is completely clean and dry, as even slight moisture can prevent the adhesive from sticking.
- Use only water for cleaning, avoiding soap or adhesive-remover residue.
- A hair-dryer on a low setting can help dry and warm the skin.
- After applying the wafer, hold it in place for at least 30 seconds to help the adhesive set.

2. Skin Protection Before Applying the Wafer:
- Consider using liquid skin protectants like Marathon Skin Protectant or 3M Cavilon Advanced Skin Protectant, which form a tougher coating and allow the wafer to bond to damaged skin.
- If the skin is only mildly irritated, standard alcohol-free skin-barrier wipes can be helpful; avoid barrier creams.
- Try the "crusting" method: lightly dust ostomy powder, wait 1–2 minutes, then dab with a barrier wipe to seal the powder before applying the wafer.

3. Pouching Systems and Accessories:
- Convatec Durahesive Extended-Wear pouches are known for strong adhesive and good performance with liquid output and challenging body contours.
- Use Convatec Stomahesive Paste or a sealing washer (ring) under the wafer to fill uneven areas around the stoma.
- Consider switching from a one-piece to a two-piece system for easier positioning and changes.
- If strong adhesives irritate the skin, consult a stoma nurse before use.

4. Extra Mechanical Support:
- Use maternity or high-waisted support underwear to keep the pouch flat and reduce tugging.
- Sleep on your side rather than on your back to lessen pressure on the wafer.

5. When to Seek Professional Help:
- If persistent leakage and skin breakdown occur, seek advice from a stoma nurse or dermatologist.
- If appliance changes remain unmanageable, discuss surgical revision or stoma relocation with your surgeon.

6. Encouragement:
- Frequent leaks are common in the first months; many people find that the right product combination and technique can dramatically reduce leaks over time.
- Don’t hesitate to ask for home nursing support and emotional help while troubleshooting.