Jeanetter wrote:

<when she pumped, one breast released milk just fine - the other not at
all. With hand expression (which I began to show the mom, but at 4 days
postpartum she was overwhelmed and weepy with a baby in NICU) I could
feel that her breasts were full and I was able to express milk, though
the ducts were very deep. I happened to have a big, glass flange that I
had used ONLY with moms with ENORMOUS breasts - but it was clean,
available and I thought why not...well the milk POURED out! >

Jeanette, I remember my first insight into this decades ago in the days
of the bicycle horn pump and 3-5 day stays. A mom developed a fever and
her baby was kept in the nursery. Her breasts, perhaps C cup size, did
not appear unusual in any way, but she was becoming exceedingly full and
uncomfortable. Without the doctor's order (supervisor insisted on that at
the time), in the middle of the night I tried to pump both sides. One
cooperated beautifully, and the other wouldn't cooperate for love nor
money! "WHY" popped into my mind. I hope that was after I had learned
about the concept of hand expression (from a Ross inservice book in the
1960's, no less! I think I had seen some cartoonish diagrams of sinuses
in a Carnation transparency book and recognized at the time that the
sinuses were placed at different depths in the two breasts.)

Jeanette again: < Just as breasts are asymmetrical (as are eyes, ears,
etc.), why not the > internal organs and ducts? > > We need to be aware
of these differences and variation and be skilled in > recognizing what
works and what doesn't. (Perhaps a pump flange will need to > be designed
that changes in size?  Why not?  Pumps now offer a large > variation in
cycling and suction!) > . . . .<we need to be aware of how to help moms
with large breasts, or at least breasts that have a lot more fat perhaps
between the skin and the ducts and not just nicely tucked in under the
glandular tissue as you see in some diagrams of the breast! >

I described a few things about the anatomy of the nipple-areolar complex
(NAC)in my RPS article. A French surgeon wrote that a defining
characteristic of the NAC is that there is no fatty tissue between the
skin and glandular tissue there. I have noticed however, that different
breasts (sometimes on the same mother), have different amounts of
connective tissue separating and/or surrounding the subareolar ducts
(designated as lactiferous sinuses in histology literature).

Lynn writes:
<On exam breasts were moderately full (not as full as I would have
expected this close to peak volumes and a poorly feding baby), sucking
was weak w/o letdown noted, particularly notable were Moms
nipples-although not exceedingly so, they are on the longer side. > . . .
<I know BWC and others have posted on nipple length in the past but I'm
wondering about this more minor variation-what do you think?>

This defining characteristic of no fat between the skin and the ductal
tissue in the NAC, allows easier access to the nerves that are converging
toward the central areola from all parts of the breast. They are close to
the surface there, and will ultimately meet deep under the nipple and
wind around each of the individual galactophores that are deep in the
center of the nipple as they extend to the openings at the tip. (ever
notice? There are never any on the side of the nipple. This seems to
apply regardless of nipple size or length. Separate Montgomery gland
openings on some areolas can produce milk, but are not connected to the
deeper glandular/ductal system.)

Myoepithelial cells surround some of the lactiferous sinuses. In addition
to responding to oxytocin, they are also capable of responding
reflexively to direct pressure on them (called the 'tap' reflex in
veterinary medicine) Ever watch kittens nurse? Calves and kids 'butt'
their moms?

As dramatic as RPS can appear when mobilizing edema out of the central
areola, I am just as impressed by its ability to stimulate MER. This
insight is especially helpful in cases where there is an apparent
mismatch between the size/vigor of the baby's mouth and the size or
length of the nipple, and also, in preparation for pumping to help
transfer milk more effectively.

References for all the above statements accompany my article. I invite
everyone to read it thoroughly and carefully, because my search for the
answers to my many "whys" led me to some fascinating references and
insights that I want to share with my colleagues all over the world.

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