Ellen writes:

<She told me it takes her an hour to get that much milk double
pumping with a Medela Pump In Style, so I observed her.  I saw her right
breast let down almost immediately, but her left breast did not let down
until about 12 minutes later.>


I am trying to visualize how such a thing could appear to happen, since the
stimulus for MER causes oxytocin release into the blood stream which should
theoretically reach the myoepithelial cells in both breasts at the same
time. I would be curious as to what you observe as far as evidence of MER in
response to triggering it by RPS (reverse pressure softening). Also, does
one nipple happen to have a short shank (the "fast" side?) and the other
nipple a longer shank??? Or do they look essentially the same??

I have made no secret of the fact that I firmly believe in the existence of
lactiferous sinuses, though I agree that the former diagrams were in error
as to their size and distribution. Have you personally tried hand expression
on each side to see if getting results requires you to place the thumb and
fingertips at a different distance from the base of the nipple on each
side?? This would give you some idea of the placement of the main
lactiferous sinuses on each side.

I am wondering if perhaps a larger flange on the side that seems to be
letting down later might be of some help. I have seen mothers in whom the
lactiferous sinuses were deeper on one side than on the other, despite the
fact that the nipples themselves looked the same size, etc. If a flange is
"hitting" in front of the sinuses in that breast, the compression against
the flange tunnel may be effectively blocking the exit of much of the milk
against the surge of the MER, and not allowing much to "escape" even between
cycles until a long period of pumping has temporarily reshaped the
subareolar tissues by the length of time spent pumping.

We would all be interested in what happens if you try these suggestions,
regardless of just how it works out.

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

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