Laurie says:
<I am findiing more and more often that mothers feel more comfortable and
get 
more milk with larger flanges, even when their nipples appear to be quite

small.>

More clinical experience pointing to the need for better understanding of
the microscopic anatomy of the nipple-areolar complex (NAC) in lactating
women. In the resting (non-lactating) breast, the discipline of histology
has found and published ample microscopic evidence of the presence of
unique anatomical structures which their discipline has officially
labeled 'lactiferous sinuses'. These are also described, complete with
measurements, in radiology literature. What purpose would nature have for
the presence of these unique structures in the non-lactating breast
except to have them waiting in readiness to proceed with temporary
developmental changes during the rest of the reproductive cycle to better
meet the needs of the human infant and child??

It is often illusory to use apparent nipple size as a guide to the
appropriate size for an efficient flange tunnel. The depth at which
lactiferous sinuses are distributed behind the base of the nipple is
individual, not only in each woman, but sometimes in each of her two
NAC's. Sometimes part of the sinuses are shallowly placed while others
are more deeply placed. In other women, they are practically all
shallowly placed, or all deeply placed. The visual size of the woman's
nipple does not necessarily bear any relationship to the placement of the
lactiferous sinuses. A woman with a small nipple may have deep sinuses,
while a woman with a large nipple, or a flat or inverted nipple may just
as well have shallow sinuses. Or vice versa, or some of both. 

If the pressure of the opening of the flange tunnel falls in front of the
lactiferous sinuses during the pumping cycle, it tends to strip the milk
back upward, even resisting much of the forward counter-push of the MER
(to say nothing of placing schear forces on the delicate thin-skinned
junction of the nipple with the areola). Larger flange tunnels allow not
only the nipple, but larger parts of the areola and the subareolar
sinuses, to enter the tunnel. This allows compression to be focused not
only beyond the skin surface of the nipple-areolar junction, but also on
the middle, or the posterior part of many of the lactiferous sinuses that
may be somewhat deeper inside the nipple-areolar complex. This thereby
offers the kind of compression you would apply to the back of a
toothpaste tube if trying to empty it more completely.

Just a random thought after reading Laura's comment. I know I am not the
only clinician who has an empirical certainty that lactiferous sinuses do
in fact, exist. I retain a fond hope that someday we may find a way to
enlist the histology and breast surgery community in directly
investigating the microscopic anatomy of the lactating breast whenever
unfortunate circumstances such as forensic care or breast disease in a
lactating woman bring about the opportunity for excision and microscopic
examination.

Jean
****************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html