Nicki wrote me privately:

<Were these live breasts or dead ones?
    I thought that was the big difference between Hartmann's ultrasounds
of the breast during a feed and all the research which was done on
cadavers.>

Some were surgical specimens from breasts removed during mastectomy. The
study of breast disease has produced a very well detailed foundation for
study of the anatomy of the pregnant and lactating breast. The article I
mentioned in the dermatology journal was by an anatomist that used
cadavers of children, adult males and females, human and monkeys, with
resting breasts. All had lactiferous sinuses, but only those of the
female have walls surrounded by thick elastic tissue. The descriptions
detail the type of cells in the walls, their shape, etc. etc. The
electron microscope pictures are very instructive.

Cadaver studies provide a great deal of information. Sir Astley Cooper's
work, which I want to obtain so I can read about it in more detail,
seemed like exquisite scientific research, to me, regardless of whether
if was done 2 centuries ago long before cameras, etc. or not. The study
of anatomy began with the study of cadavers.

The one small picture I saw of his drawing did not look at all like the
simplistic "cartoonish" diagrams we have so often seen. In fact, it
looked to me much more like the Medela diagram (on page 17 of the new
Breastfeeding Answer Book) that grew out of Hartmann's group's work.

I think it very unprofessional and skewed like pure advertising "hype" to
describe Cooper's work in such a way as to encourage the lactation
community to ridicule it, to try to discredit it.  I am not saying that I
question the value of ultrasound. It has an important place in the study
of the anatomy of the living breast, active or resting.

What I do question is the interpretation given to what was shown on the
ultrasounds done on the un-nursed breast during established lactation. An
entirely different type of information is available through the use of
the microscope, and I think the two, plus any other means, such as
ductography, when it can ethically be done, should be used in the final
synthesis of the true nature of the lactiferous sinuses.

Russo and Russo, describing the breast as a whole wrote:
"This complex organ therefore has to be described in its anatomy,
histology, ultrastructure, physiology, or response to hormones not as a
static picture, but as a dynamic phenomenon in which each phase is
transitory and heavily dependent on the age at which it is studied, and
the specific conditions of the host . . . the development of the mammary
gland has to be evaluated based on the architecture of the organ at each
given period of time for each individual woman."
Russo J, lRusso IH Development of the Human Mammary Gland in: The Mammary
Gland, Development, Regulation, and Function ed. by Neville MC, Daniels
CW 1987 Plenum Press, NY. pp 67-93.
My guess is that when such studies of unfortunate pregnant and newly
lactating mothers who die by accident or lose their breasts to cancer are
done, we will find that the lactiferous sinuses slowly begin to enlarge
and balloon slightly during late pregnancy as colostrum begins to form
and be moved forward by pressure of newly forming colostrum backing up in
the breast, and by gentle MER's that probably accompany Braxton Hicks
contractions. Even then the sinuses still measure in millimeters as to
thickness and length. An experienced examiner can easily palpate them
during the late third trimester.

Elastic sheets and fibers are curled when relaxed, and uncurl when
stretching expands them, and they re-curl in different patterns when they
relax again. Elasticity "develops" when elastic fibers have uncurled and
curled often enough, according to the histology lab books. I believe that
is part of what is happening to the walls of the lactiferous sinuses in
the first 3-4 weeks of initial direct breastfeeding, or even pumping.

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

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