Thank you Laurie for your comments and question about a resolution of the two separate questions you mentioned. 
 
1) the question on whether RPS could safely be used (without liability concerns) by a professional HCP directly on the mother with an implant or not, and 
2) whether the mother with the implant might actually be at higher risk of swelling and firmness of both the breast and the areola and for whom RPS might be especially helpful. 
 
 
The potential for liability (for HCP's) was my serious concern in making the original recommendation. In retrospect, I realize I did not read up on implants. However, the suggestion to include the caution may even have been made at the suggestion of the JHL editorial review board, but I can't be sure 8-9 years later. It makes me feel considerably better to learn what your surgeon told you. At the very least, the HCP could first ask the mother about her surgeon's instructions about compression. However, even if any mother did receive the same type of instructions from her surgeon, the "self-application" instruction would still work. Her judgement would be enhanced by having been so instructed by the person who put the implants in and was best suited to judge about safety of compression. The quality of the verbal instruction and supervision to see that she "gets it" would still work.  
 

I do feel very certain that actual kinesthetic learning is more likely to be remembered, especially if the softened areola is then compared with the firm areola. I have seen many a "lightbulb" suddenly turn on over a mother's head by doing this comparison. I believe that kinesthetic experience helps moms "get it" more certainly than "suggestion-in-passing" type verbal instructions at discharge, or written/illustrated instruction sheets alone. 
 
 
However, the written/illustrated instructions allow the mother to review them later (if she remembers to look at them) when breast swelling often increases considerably after she gets home. I believe the written/illustrated instructions might also be helpful to her significant others, (who are often the "24/7 boots on the ground" help available to a mother when she is experiencing the most severe part of her swelling.) They may or may not have had the same kind of personal experience a generation or two ago. 
 
 
I want to emphasize again very strongly that any mother with any degree of  pendulousnes, or a mom with very swollen breasts, benefits by lying at least three-fourths of the way back, or even supine, to utilize gravity while doing RPS, then remaining "laid-back" at least for latching itself, to hold excess interstitial fluid "at bay" for a longer window for latching.
 
 
I am still of the impression that the mother's simultaneous use of her own six fingers gives possibly the best leverage for RPS, but I have noticed that it seems awkward for many mothers to coordinate in the way I originally explained it (which was something like "Bend your fingertips and place them in a circle around the base of the nipple." Since fingers only bend one direction, this method would probably not work well for the HCP, though seemingly explained thus in one major BF textbook;-)
 
 
I have found a better way to explain this position to help a mother coordinate her fingers more easily:
 
1) Hold your ring fingers together tip to tip, placing them straight under the bottom edge of your nipple.
2) Hold your index (or first) fingers together tip to tip, placing them straight above the upper edge of your nipple.
3) Then bend each middle finger to fill in the space on each side of your nipple.
4) Then press straight inward (toward your heart) and count slowly to 50, and count very very slowly if you feel very, very swollen. 
 
 
(I am indebted to Dr. Gail Hertz for this suggestion as it is very specific to the mother's own degree of swelling yet removes chances of "short guesstimating" on one extreme, or its opposite: tension or "requirement" for a clock for clockwatching.) 
 
 
Diane Wiessinger pointed out to me early on that many mothers would feel empowered by performing RPS on themselves vs. having the professional (with permission) actually perform RPS on her breast. When all is said and done, I believe it comes down to a judgement call in the individual situation, determined by the individual comfort levels, communication styles or barriers, and boundary preferences of the individuals involved. 
 
 
I imagine that some practitioners, perhaps especially male pediatricians, might feel uncomfortable with the idea of applying or demonstrating RPS directly to the mother's breast. (Not Dr. Jack Newman, whom I have found to be a very staunch supporter;-) I don't have the impression that a male obstetrician would be likely to feel uncomfortable in this same situation, if he realized that the time he spent doing so was really valuable to the mother.
 
 
I once made powerpoint slides of a friend modeling her clothed chest with a demo breast placed on the outside of her gown/t-shirt. I asked her husband to put on a sport coat so that his jacket sleeve, shirt cuff and hands would appear on the slide, to suggest a male physician on rounds, using the demo breast to instruct the mom. One slide shows him applying RPS directly to the demo breast (with thumbs, the easiest way when the HCP is in the opposite plane from mom).  Another slide shows him placing his thumbs directly on top of the mother's fingers, to help add pressure while she herself is applying RPS on the demo breast. 
 
 
I have named a few colleagues above, but no doubt left out many whose feedback helped me during the development of RPS. I continue to welcome feedback, negative or positive, as RPS still seems to be a work in progress. (I can't prove it but I feel relatively certain that I have helped two experienced mothers cope successfully with what felt to me like a galactocele, which neither had ever had with a previous baby.)
 

I would be interested in hearing from any LC,  nurse or physician "fans of RPS" who may have shared its message with physician colleagues. What, if any, have been the reactions? (I am gratified that it appears in several ABM protocols.) Is it worth an RN/LC attempting to "crack" a medical magazine, and if so which one(s) might be most likely to accept an article from a non-physician?? Or would it require a physician as co-author??
 

K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC     Dayton OH

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