I have seen Prof Hartmann present the work done by Donna Ramsay on 
ultrasounding the breast several times now, however at the recent New 
Zealand Lactation Consultant's conference (fantastic conference - well done 
organisers!) - the whole Hartmann team of researchers was present to 
present their work not only as lectures, but also they did a couple of 
workshops where mothers where ultrasounded right there in front of our 
eyes. It was an excellent learning experience.

Donna was very easily able to locate and visualise the ducts, and remain on 
a duct before, during and after milk ejection. Even I could read the 
ultrasound to that extent (said by me who is hopeless at reading 
ultrasounds!). The ultrasound probe/transducer was positioned from the 
nipple following the course of the duct for the width of the transducer. A 
breast pump was being used on the opposite breast.

We could see that there was no dilatation between the base of the nipple 
and the length of the duct that we could see - until milk ejection!! Donna 
would call out 'milk ejection' just as the duct started to dilate, and 
after that we could see over on the other breast the volume of milk being 
removed suddenly go up, and most of the time the mother wasn't able to say 
that she felt the milk ejection. After the milk ejection subsided, so did 
the duct. Donna though was able to pick it before either the mother or the 
milk flow increasing noticeably.

Donna has found that ducts nearly always branch within millimeters of the 
base of the nipple, and at the point of branching the duct is a little 
wider (as you find when two rivers join) - but it's not a sinus.
As that milk flows down it is definitely an expanded duct, and you can 
actually see the milk flowing.

These ultrasounds are being done on live, lactating women - that seems to 
me to be the group that is most relevant to us. She mentioned that the 
ducts are very fine and intermingled amongst the adipose tissue. A passing 
comment she made was that she thinks it would be exceptionally difficult 
for a plastic surgeon to preserve glandular tissue during reduction 
mammaplasty. This was confirmed by the article published in the latest JHL 
too by a plastic surgeon.

Now, what happens to that duct when a mother is engorged I don't know. I 
didn't ask Donna if she has ultrasounded women at this time. Perhaps there 
is so much milk in the alveoli that the excess is forced down the ducts and 
in their resting state they are expanded and palpable. Donna noted that 
when she ultrasounds a blocked duct that it is non-compressible. Could this 
be what some of you are feeling at this time?

During normal lactation (ie no blocked ducts, no engorgement) she did say 
that if she puts a little too much pressure on the transducer that she very 
easily occludes the duct. She feels that this correlates with our clinical 
experience where we have found that a tight bra or constriction on the 
breast somewhere will result in blocked ducts. Ordinarily the ducts are 
impossible to palpate.

Everyone's anatomy is different of course. Some women have very wide ducts, 
and some have very narrow ducts. Some women can barely express half a mil 
of milk before milk ejection, while others may get several mils. This could 
be as a product of the width of their ducts, or perhaps they are actually 
mechanically expressing the alveoli that are beneath the areola.

This research would not have been possible without the assistance of the 
corporate world. Money for these things has to come from somewhere, and 
while Prof Hartmann receives money from some non-profit organisations and 
the government I would guess that they are not able to fund to the extent 
that is needed. Medela appears to me to be a good corporate citizen and has 
supported breastfeeding and breastfeeding mothers unwaveringly. Please 
enlighten me if I'm wrong.
The research on pumping and all their findings have been dispersed and 
published far and wide. There is no reason why every other pump company 
cannot make use of the information to improve their pumps too. That's what 
we want - really good, efficient pumps. There has been no secrecy in this - 
all of the researchers findings have been published. Medela deserves to 
have a great pump because they have put their money where their mouth is 
and supported an excellent research team to get the best of information to 
help make the best of pumps for mothers. Who else was going to do this?

Denise
PS: Just as an LOL - it is in my best interests if this team stops work 
today - every time they publish it creates hours of work for me and all the 
other lactation educators updating all our courses!!!

***************************************
Denise Fisher
Health e-Learning
http://www.health-e-learning.com
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