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Subject:
From:
"Kermaline J. Cotterman" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 7 Mar 2004 20:47:10 -0500
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Catherine writes:
<. . . . .  including milk
leaking from pores on the areola in the mom with reduction mammaplasty
14 years ago.  I had a mom with free nipple grafts (the most destructive
form of reduction) 25 years ago, who made all he needed less 4 oz a day
at her baby's peak intake.  If she had gotten a better start, like your
client, I bet she would have done even better.  She also had extensive
"ectopic milk pores" on her areola, and we took advantage of this by
latching the baby so his tongue covered as many of them as possible.
Bet these could be signs of extensive recanalization in the breast.
I've seen poorer results from moms who do not have these ectopic pores.

Anyone else see this phenomena, or do we have an n of 2 here?>

From a very interesting article:
Montagna W, Macpherson E, Some Neglected Aspects of the Anatomy of Human
Breasts, Journ Inv Derm, July 1974, Vol 63;1: p. 10-16.
" . . .Morpologic preparations show only a few recognizable nerve end
organs at the tip of the nipple around the galactophores, and practically
none at its sides; in the areola, sensory nerves can be found only around
the galactophores of the glands of Montgomery.  . . . . .In addition,
much unnecessary confusion persists about the cutaneous appendages in the
areola of the breast, especially the glands of Montgomery, which have
been variously referred to as minute or accessory mammary glands or
intermediates between mammary and sweat glands. We have dispelled this
confusion by showing that these are true mammary glands whose ducts and
secretory parenchyma are identical with those of the mammary glands that
open at the tip of the nipple. Since they are often functional during
lactation, they must be consider integral elements of the lactiferous
apparatus.. . . . .

In split-skin preparations, the ducts of Montgomery glands are clearly
seen to be identical with those that open at the surface of the nipple
and they are always seen in conjunction with large sebaceous glands. Some
sweat glands can be seen to open onto the areola. The galactophores of
Montgomery glands are found in loose groups of 3-6, arranged in various
patterns: some form a circle around a large sebaceous gland, others are
aligned in a row with a sebaceous gland at one or both ends, and a few
grow singly. Sebaceous glands often empty near or into these
galactophores but some groups do not have sebaceous glands nearby.
Furthermore, some large sebaceous follicles grow independent of the
Montgomery ducts, 6-10 groups of which are sometimes randomly distributed
within the two-thirds of the areola that immediately surrounds the
nipple. . . .

One of the remarkable findings in our studies is the absence of apocrine
glands except in the periphery of the areola. The so-called "apocrine"
glands reported by other authors are actually lactiferous sinuses, which
differ structurally from true apocrine glands.

. . . . .We have shown that the tubercles of Montgomery, long subjects of
anatomic controversy, are integral parts of the mammary apparatus. The
structure of the ducts in them and of the parenchyma of the gland is
simiilsr in every respect to that of the glands that emerge at the
nipples. These are neither smaller nor accessory glands, but are a part
of the total breast tissue. They are usually functional during lactation
when milk can be expressed from them."

They give as one of their references an earlier work that I haven't yet
gotten, but would love to get:

Montagna, W. Histology and cytochemistry of human skin. XXXV. The nipple
and areola. Br J Dermatol 83:1-13, 1970 (Jubilee Issue)

So yes, let's take Catherine's suggestion : <we took advantage of this by
latching the baby so his tongue covered as many of them as possible.)

One more benefit of asymmetric latch!

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

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