<>I was at a recent meeting and heard the information that the milk
sinuses
>_do not exist_ passed along as fact.  Does anyone have the cite for
this?
>Is the jury back in on this? I am utterly empty-handed on this... and
there
>is little I dislike more than having information that is out of date.>

The jury is going to be out for a long long time on this one, IME.

I was recently hunting for a publication on this work of Donna Ramsey and
Peter Hartmann to use as a reference. Cathy Fetherston kindly provided me
with 2 citations, both of which are still at the stage of reports of the
proceedings of x or y or z (not too widely known except down under in OZ)
societies.

I would not have the temerity to "argue" with a scholar so knowledgeable,
respected and courteous as Dr. Hartmann. I have sought him out at breaks
between lectures, at 2 conferences, to seek information from him and
share some of my reading and references and clinical impressions. He was
most kind in encouraging my questions and my interest.

If I am paraphrasing him correctly, he tells us that  "we are unable to
demonstrate with ultrasound the existence of milk sinuses in the exact
form and distribution we have been trained to imagine by the textbook
drawings." That is a far, far distance from saying they do not exist -
period.

I have a particular interest in milk sinuses from a clinical standpoint.
I believe I have palpated them in literally thousands of pregnant and
lactating breasts while doing nipple function assessments over the course
of nearly 4 decades. I have had many question about what I was palpating.

In order to answer my own questions, I have sought out primary references
and have seen many different types of drawings of them in various types
of references which do not all "compute" with what I have been palpating.
I have also seen references with electron microscope photographs of them.

I agree with Dr. Hartmann that many of these drawings have been based on
post mortem studies, done under a microscope. "Lactiferous sinus" is part
of the official nomenclature of the breast in the specialties of
pathology and breast surgery and I am fascinated with the descriptions I
have found in that type of texts.

As I see it, part of the problem lies in the fact that most of the
existing studies have apparently been done on inactive (non-pregnant,
non-lactating) breasts. Gruesome as it sounds, the accidental deaths of
women in the third trimester of pregnancy or while lactating, would
provide forensic pathologists with the only type of specimen that might
answer your question precisely.

Or perhaps, breast reduction or breast disease in a recently lactating
woman might still
provide specimen material that, if injected with paraffin or dye, might
provide a more accurate picture of what some milk sinuses might look like
in some recently active (not completely involuted) breasts.

It is my guess that while many similarities would be found, no two
breasts would be exactly alike, though. So drawings would still be
imaginative generalized concepts, just better founded.

So you are not behind. You are simply a bystander perched on the
threshhold of an interesting scientific quest, listening to different
viewpoints. Not too unlike the fable of the blind men describing an
elephant, really.

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

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