Jean:  You described to a "T" hand expression within the confines of 
mechanical pumping with your advice on achieving maximum pumping 
effectiveness.  I agree with you that there are "things" in the nipple-
areolar complex that could probably be called "sinuses".  Anyone who hand 
expresses has felt these "things" rhythmically empty and refill during the 
act of hand expression.  I knew I had a good flow going without even having 
to see milk squirting from my breast by the "feel".  My areola and nipple 
would feel very spongy when full, and like normal tissue during 
the "compression" phase - when my fingers were actually compressing the 
areola. The key is a consistent rhythm, most closely mimicing the baby's 
suck rhythm.  I didn't think it could be described, but you did it!

Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL   USA

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