Laura wrote:
<For the breastfeeding physician with plugs, I am thinking maybe there is
some kind of pressure on the nipple pores. I heard you say no tight bra, but
perhaps some other clothing or position? Is she staying well hydrated? Maybe
that would help too.
For the recurrent mastitis client with a new baby and very painful breast -
I think prophylactic antibiotics and anti-inflammatory agents should be
considered, in addition to thorough breast emptying. Analgesics. Does she
have a tendency to oversupply? Keep that in mind with management of that.>
I have a question of idle curiosity that won't help a soul with this
problem, for we are all "stuck" with our particular kind of nipple anatomy,
but I find myself curious.
This is about plugs that seem to be in the nipple-areolar area themselves,
not plugs up higher in the duct system.
Is the length (or height) of the mother's nipple a factor? Some moms have
more connective tissue so that their nipple is about 0.5 to perhaps 1.0 cm
in thickness or height, whereas some mothers, while not having actually flat
nipples, have so little connective tissue in them that they seem "shallow"
(< 0.25 cm high, even when stimulated to evert.) In essence, this would mean
that mothers with "shallow" nipples would have shorter galactophores in the
center of the nipple than the mothers whose nipples were what I call a more
"generic" height. This would mean the subareolar ductal system begins much
closer to the surface of the nipple in mothers with shallow nipples.
There is what is referred to as a "squamo-columnar junction" inside the
nipple-areolar complex. The type of skin cell that lines the galactophores
in the nipple is the same type on the surface of the body: squamous
epithelial. They are flat and scale like, and theiir function is to form a
protective barrier and these cells don't "stretch" much or change shape
very easily. In fact, in the resting breast and the pregnant breast, they
normally sluff off and fill the galactophore with keratin debris.
Histologists report that there is a sudden end to that type of lining cell -
a very obvious junction - where it meets the lactiferous sinuses (or
subareolar ducts if you prefer). From that junction on inward, the ductal
system is lined with a different type of cells that tend to change shape to
provide more area as the duct expands (cell temporarily gets thinner, but
spreads out over more area sort of like a marshmallow gets (permanently!)
when you heat it between two graham crackers;-)
So my question is probably "Is there any noticeable difference in the rate
of blebs or plugs within the nipple-areolar complex depending on the
"height" of the mother's nipple (e.g. the probable length of the squamous
cell lined galactophores)?" As Dr. Jennifer keeps wishing, maybe if someone
would dissect and examine plugs under the microscope, would they find that
there is a keratin debris component mixed with the milk fat that helps to
form the plug??? If I'm interpreting what I read correctly, this is the area
where ductal ectasia can form in the resting breast.
Just picking your brains about what you see in practice, for my idle
curiousity.
Jean
**********
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA
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