<I would love to see these references and pictures as you describe.>

Azzopardi JG, Ahmed A, Millis RR. Nomenclature of the Microanatomy of the
Breast: Parts Affected in Different Diseases: Normal Structure and
Involution, In: Problems in Breast Pathology In: Major Problems in
Pathology, Vol. 11 in series, Bennington JL, Ed., W. B. Saunders Co.
Ltd., London, 1979. p. 9, 81, 335, 384.

Haagensen CD, Diseases of the Breast, Third Edition 1986 W.B. Saunders
Co: West Washington Square, Philadelphia, PA 19105, p. 10-12.

<Also what are the certain disease processes that affect just the
lactiferous
sinuses?>

Lactiferous fistula. Passaro ME, Broughan TA, Sebek BA, Esselstyn CB Jr.
J Am Coll Surg. 1994 Jan;178(1):29-32.

<Lactiferous fistula, or Zuska's disease, is a rare recurrent condition
characterized by draining abscesses about the nipple on one or both
breasts. Because little is known about the disease, it is often
misdiagnosed and inappropriately treated.>

< On histologic examination, we found that, in all instances,
keratinizing squamous epithelium had replaced the lining of one or more
lactiferous ducts for a variable distance into the subareolar tissue.>

In rereading the abstract, I see the words "lactiferous sinus" are not
actually mentioned. I'm sure I jumped to the conclusion that the
condition happened in the lactiferous sinuses, because they are the last
part of the ductal system ending in the subareolar area and normally
lined with cuboidal cells.

At the junction of the lactiferous sinus with the galactophore or
collecting duct (which passes from the subareolar area through the nipple
and exits at the tip of the nipple), the lining cell type normally
changes abruptly to keratinizing squamous epithelial cells which continue
onto the skin surface of the nipple and the rest of our bodies. In the
resting breast, the collecting duct is plugged with the debris of
desquamated keratin cells.

I find this fact highly significant. As the breast begins to manufacture
colostrum from mid-pregnancy on, in my mind's eye, I can see the droplets
beginning to collect in the contracted sinuses, eventually "backing up" a
little when it meets the junction, thus beginning to dilate the sinus and
produce the bulge prenatally.

I am 100% positive in my mind that that is what I have been palpating in
thousands of breasts from the time I began to do prenatal nipple function
assessments in the early 1970's.

When I attended one of Chele Marmet's seminars where she taught fingertip
expression using volunteer nursing mothers, I remember remarking to
myself "Why these don't feel anything like I feel on moms during the
mid-3rd trimester and early puerpuerium!"

I have it figured out that weeks of nursing or pumping, by the principle
of tissue expansion, must cause them to reach their full elasticity and
respond easily to the forces of MER and suckling that fill and empty
them.

Therefore, at full, established lactation, ultrasound must reveal no more
bulging than what occurs to the rest of the ducts, and they feel no
different from the rest of the ducts when palpated.

<I am not saying they are not present but what I saw on ultrasound right
next
to the nipple was no ballooning out sinuses.>

That's why I said in my previous post:

<What is missing from our understanding, it seems to me, is the process
that happens to the sinuses from the time they are seen two-dimensionally
under a microscope, contracted, in the non-pregnant breast, until the
time they are well expanded in full lactation and "caught in the act of
functioning" during these shadowy, still two dimensional ultrasound
images.

I maintain that between these two extremes are several stages where the
"bulging" state naturally occurs. An experienced examiner can palpate
them in most mothers from the mid-third trimester onward, and clearly
feel their slight bulging throughout the first weeks and possibly months
of lactation until they have developed their full elasticity and the
contour the researchers describe at that point in time when these
ultrasounds have been filmed. >

< The breast structure and function
has always fascinated me. >

That makes at least two of us! For years, while I was palpating and
demonstrating fingertip expression, I remember often saying to myself
"That's strange! I wonder why this feels or acts different than the last
several I palpated, etc. etc." Eventually, I began searching now and then
in the medical libraries for clues in all kinds of journals and texts,
and gradually found what I felt were satisfactory answers to my
questions.

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

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