Kathy Leeper writes:
<I cannot come to terms with a physiologic reason why skin would "grow
over" the nipple pore. I agree that an "old", recurrent bleb can start to
look like that, but I can't believe that is the initial mechanism that
gets it all started. >

I don't know if it is pertinent, but FWIW, keratiniing squamous
epithelium, the kind of skin cells that comprise the outer skin of the
nipple, normally continue on down as the lining of the galactophores as
they pass into and through the nipple. At some point deeper inside or
near the base of the nipple, there is a distinct squamo-columnar junction
as the galactophores meet the subareolar ducts, (or lactiferous sinuses
as the histologists official nomenclature refers to the ductal structures
in that area. This is described in one histology text as the location
where form of breast pathology known as ductal ectasia begins to take
place.)  In the resting and pregnant breast, the galactophores are
normally plugged with keratin debris. 

<I can't remember where I heard the theory, but what makes the most sense
to me based on what I see is that the duct wall gets damaged (from poor
latch or excessive pump suction) and the milk actually dissects (or
burrows) out into the tissue surrounding the duct and then can't get out.
The mom describes excruciating pain, which seems way out of proportion to
what you see. I attribute this to stretching of the duct walls near the
opening, which stretches the sensory nerves, much like a very full
bladder feels. It makes sense to me that the wall of the duct would try
and "heal" after lancing with the needle, requiring repeat lancing. Often
these ductal pores never look the same again...often they appear much
wider, or "dilated". >
Your explanation makes a lot of sense, at least till someone biopsies
some, as you suggest. But since a biopsy itself would further insult the
nipple, it would be helpful if someone could at least "capture" one of
the plugs at least, and dissect it under the microscope to see if it's
keratin debris, milk fat or what. How about you Kathy? . 
Since it's now past midnite, I guess I can count this as my first post on
a new date!

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

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