While searching for something else, I came across this interesting
article.  A study demonstrated that the amount of pain (mastalgia) was
directly related to the dilation size of milk ducts. Larger=more pain.
After seeing the Austrailian demonstration of the expansion of the ducts
during MER, it's no wonder some women describe letdown as "painful".

Duct Ectasia Linked to Mastalgia Severity
Laurie Barclay, MD
Jan. 27, 2003 — For the first time, duct ectasia has been shown to be a
major factor associated with the severity of mastalgia, according to a
report in the January issue of Obstetrics and Gynecology. Furthermore, the
site of pain was positively correlated with the site of duct dilation.
"Knowledge of the etiology of breast pain is incomplete, and medical means
of resolving the disorder are rather unsatisfactory," write Friedolf
Peters, PhD, and colleagues from St. Hildegardis Hospital in Mainz,
Germany. "This investigation therefore applied ultrasonography to mastalgia
patients to investigate morphological structures and to obtain further
insights into the pathophysiology of mastalgia."
Of 335 premenopausal women enrolled in a genital and breast cancer
screening program, 123 were asymptomatic and 212 complained of breast pain,
including 136 with cyclical and 76 with noncyclical mastalgia.
The maximum mean width of the milk ducts measured by ultrasonography was
1.8 ± 0.84 mm in asymptomatic women, 2.34 ± 1.10 mm in cyclical mastalgia,
and 3.89 ± 1.26 mm in noncyclical mastalgia (P < .001). Pain intensity was
positively correlated with the width of the milk ducts (r =.5008; P
< .001). In patients with noncyclical mastalgia, reports of pain location
corresponded to sites of dilated ducts visualized by ultrasonography (P
< .001).
"The results of this study demonstrate that duct ectasia is a major factor
in mastalgia," the authors write. "The degree of duct dilatation correlates
positively with the intensity of breast pain. In the noncyclical type of
pain, there is a positive correlation between the site of duct dilatation
and the site of pain."
Obstet Gynecol. 2003;101:54-60
Reviewed by Gary D. Vogin, MD

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