Denise writes:
<May I encourage people not to use the site which tells mothers to find
their lactiferous sinuses though because they may be there a very long
time. I think with all the ultrasound work that has been done in the last
2 or 3 years now, added to the X-ray that I first saw in Riordan &
Auerbach 1st ed. from a 1989 text we can be sure that lactiferous sinuses
don't exist. >


There are many other professionals who study the inside of the breast
besides those interested in lactation. I feel confident in continuing to
use the same terminology used by other disciplines to describe what I
myself, and many of my colleagues, have palpated and taught mothers to
palpate for years. I believe that perceiving their presence and location
have great relevance for lactation professionals, not only for
comfortable initiation of breastfeeding and effective hand expression,
but for size selection for pump flanges.


Histologists, breast surgeons and general radiologists will continue to
use the term "lactiferous sinus" because precise terminology is very
important to the study of breast disease. In the resting breast (the only
phase commonly available to be studied under a microscope), there is very
definitely something obviously different about the cell type, the
squamo-columnar junction and the distinct anatomic configuration of that
portion of the ductal system that is immediately attached to the
galactophores that exit the nipple. Only forensic science, or a rare
surgical specimen could possibly provide microscopic evidence of what
temporary changes that pregnancy, early breastfeeding, established
breastfeeding and eventual weaning may bring about in the size and
microscopic characteristics of the sinuses.


Laciferous sinuses definitely do exist. I draw your attention to 3 of the
many objective examples I found by googling 'lactiferous sinus'. Find
reference #30 on page 3, click 'Blue Histology-Female Reproductive
System'. (This is the histology website of the Universtiy of Western
Australia.) Directly below the blue topic section section on Mammary
Gland, look for  'Additional resources'. Click 'Large images', type in
lactiferous sinus in the right-hand blank on the next screen, then click
'02' on the next screen to bring up a very clear color slide of a
microscope view of a cross section of a nipple-areolar complex in a
resting breast. Scroll the screen and note the 'corrugated' appearance of
the 2 lactiferous sinuses captured in that specimen.


For an example of radiology use, continue on google to page 7, reference
#66 'Dynamic Breast Anatomy', to find an ultrasound description including
measurement of the size of the sinuses (in the resting breast). You will
find the surgical/histological use of the term describing breast disease
in the lactiferous sinuses on page 14, reference #138, 'Labrea . . . .
Journal',  the summary of the 9th talk 'Management of Difficult Benign
Breast Problems'.


I too have heard the statement "There are no lactiferous sinuses" made by
 members of Dr. Hartmann's team. However, when I questioned him directly,
his exact words were "We are unable to demonstrate the presence of
lactiferous sinuses on ultrasound." To me, those two statements do not
have the same  meanings. All other reproductive organs undergo changes in
size, location and consistency during different phases of reproduction.
It is conceivable that repeated stretching of lactiferous sinuses also
brings about temporary changes in appearance on ultrasound or under a
microscope.

I am unaware of any studies done in the last trimester of pregnancy or in
the early weeks before breastfeeding has become well established. With
all due respect, I cannot imagine that funding for any study during these
specific intermediate phases of breast development, and the funding of
repeated, world wide seminars demonstrating (advertising) any result
thereof, would seem to have sufficient potential to profit a company
hoping perhaps to "pull the wool over my eyes" about breast anatomy to
better sell more breast pumps for established lactation.

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

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