<After reviewing all medical history and development, the only thing I
could
note is that she had both nipples pierced at one time and had let the
piercing heal over.
I felt no significant scar tissue but....it's the only
thing that looks like it may be causing this varience.>

My guess is that the milk sinuses may be more deeply placed in the one
breast that the problem occurred with. This is an artifact of fetal
development, and can be individual to each separate breast.

I talked to Peter Hartmann at a convention about some of his group's
newest findings. He expressed it in terms of not being able to identify
milk sinuses as a distinct entity per se by ultrasound, but each one
perhaps a widening where 2 (or more) ducts merge to form the sinus
resulting in a single duct (galactophore) (per 2 merged ducts) then
passing through the nipple.

But to turn it around, from a developmental view, the original
downgrowths in the embryological period eventually began to DI-verge as
they grew inward into the connective/fatty tissue substrate during later
fetal life.

I personally don't think that nipple jewelry could possibly have pierced
each and every one of the galactophores coming from the sinuses. There
should be plenty more. One phuysician in England is even inserting
bar-bell jewelry under the base of the nipple (and obviously right
through a galactophore or two) as a treatment for inverted nipples. And
for that matter, there now seem to be numerous reports in the literature
where breast reduction with reattachment of the nipple allowed apparent
"recanalization" to occur.

Try fingertip extraction (3rd trimester is not too early) further away
from the base of the nipple to help identify where the sinuses are. They
are usually very plain to feel, but don't expect the "bicycle wheel"
pattern seen in so many diagrams. If you find what I think you'll find,
be sure to show her where and how to fingertip express, and that she may
have to help a bit (with compression or a bit of pumping) till baby's
jaws grow bigger.

Moms with this deeper placement need larger flanges if they use a
breastpump. Also, they need to have the importance of MER as the primary
force in milk removal emphasized.

I think teaching breast compression would also be helpful in assuring the
milk is more thoroughly removed at a feeding. And that thorough and
frequent removal is what drives supply. I suspect that due to deep milk
reservoirs, milk was not being removed thoroughly, and was therefore
signaling that breast to limit production.

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

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