Hi all,
The knack in hand epxression is finding exactly where the lactiferous sinuses
are, and how deep. Imagine a pea inside a thin straw, and each breast having
a cluster of 10-20 straws, each with a pea inside.  The sinuses are softer
than peas, more like little milk-filled pillows or tiny cylindrical squirt
guns. When you've located the pillow, press the milk out with your thumb on
top and forefinger or middle finger underneath, starting the movement on the
chest-side of the bulge and rolling across the pillow toward the nipple side.
The pillows don't move inside the straw. Another way of imagining the sinuses
is weak spots in a garden hose that bulge out with collected water - if you
step on the bulge, it squirts. The trick is to find the bulges - they're only
about 1/4" long.

Start your search with your fingers around the edge of the areola, about 1.5
inches back from the nipple tip. Go closer to the nipple or back away from it
till you find them. They may be on the surface or deep in the breast, like
the core of an apple. Use enough pressure to squirt out milk if it's there.
Once you've found them, you'll be amazed how easy it is to press out milk. It
usually sprays across the room if you're in the right place.

THIS is what "proper positioning" is all about - getting the sinuses inside
the baby's mouth, over the tongue. The baby should be positioned with her
upper gum ridge at or on the chest side of the milk sinuses; her tongue can
press/strip the milk out of the pillows if her chin is up against the breast.
Assuming the tongue is working well, of course. But that's another lecture.
 This fixes at least 80% of the BF problems I see.

If you get really, really good at this, you can palpate (feel) them in a
non-lactating breast.

Linda Smith, BSE, FACCE, IBCLC, private practice in Dayton OH
Now, shall I describe how to do a backstroke flip turn - with words, no
gestures?