Jeanette,

I agree with what you say about the difference between what was said and
what we as listeners pick up. I was also privileged to hear Dr. Hartmann
10 days ago, and of course, I came with my own mental agenda in place.

I have talked to him about it several times. He is a most gracious and
humble man, and I respect him, his work and the work of his graduate
students. So please take the following comments in that context.

< why are we upset that plastic surgeons don't know about breasts - >

I hope you meant that plastic surgeons don't seem to know a lot about
*lactation and the proecess of breastfeeding*, Jeanette. I regularly
visit the plastic surgery literature in my quest for understanding
inverted nipples better. I continue to find a lot of valuable references
there giving me a lot of insights.

Also someone said that surgeons have a hard time differentiating breast
tissue due to the blanching during surgery.

In my reading, I have seen comments by breast surgeons whose specialty is
diagnosing and removing cancer, to the effect that the parenchymal
tissues of the breast (ducts and glandular tissue)are so integrated with
the stromal tissue (connective, fatty, vascular, lymphatic etc.) that
even though each lobe is separate when traced under the microscope, there
are no clear demarcations visible to the naked eye to show where one lobe
ends and another begins.

In addition the involution and redevelopment of some of both stroma and
parenchyma is constantly changing during the menses, pregnancy
interrupted in any fashion at any stage, pregnancy at term, in mothers
who do not breastfeed and mothers who do, and those who have never been
pregnant, and those who are not currently pregnant.

I have also seen references in histological literature that depending on
which direction a slice of tissue is dissected for viewing under the
microscope, pathologists themselves often find it confusing to identify
some of the structures.

I would hope that our medical colleagues and our laboratory technology
colleagues on this list might help us enlist the help of these other
specialties to more clearly define the anatomy.

I do not mean to put down ultrasounds in the least. But they are shadows.
And shadows need interpretation. Let's not ignore what has also been seen
under microscopes for years, even if some of it has been done on
autopsies of women not in active reproduction stages at the time of
death.

Shadows viewed during full physiologic activity are very, very different
than those same areas viewed under a microscope during either
physiologically active or inactive phases.

We need added insights from all specialists, including radiologist,
coroners, forensic pathologists and medical school anatomists, those who
do frozen sections, etc. In short, we need the findings of any who have
opportunities during the course of their duties to do scientific and/or
clinical examination of the female breast at any phase of the
reproductive cycle.

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

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