Manual Expression of Your Breasts by Ken L. Smith

Manual Expression of Your Breasts
by Ken L. Smith

The best method of removing milk from your breasts is by allowing your infant to suckle with its mouth. Your breasts are designed to produce milk when a tongue presses your areola area (darker pigmented circle surrounding your nipple) up against the roof of a mouth, applying a slight suction to carry away your milk as it is produced.

When you are not able to be with the one that your milk is intended for, sue to such reasons as sickness or travel or a busy work schedule, there are two other options for expressing your milk. The second best method is called Manual Expression, and consists of using your hands to express your milk from your breasts. A third method is using a breast pump. A breast pump is effective if you are in full-time lactation, but if you are attempting to re-lactate after a period of time of no lactation, or you are attempting to lactate without the benefit of ever having been pregnant, the breast pump may not be enough of a stimulus to your breasts to encourage them to produce milk. It takes deep stroking of your breast lobules (acini) (where your milk is manufactured) and your milk ducts (lactiferous ducts) that lead from your lobules to your nipple. This includes the ampullae that are located just behind your nipples. You can find drawings of the interior of your breast at the following locations:

http://www.breastnotes.com/anatomy/anatomy-insidebreast.html

and:

http://www.breastnotes.com/anatomy/anatomy-inside-nipple.html

If you want to manually express (express by hand) your milk from your breasts, you can start by standing in the front of a mirror (just this first time). Look at your left breast and imagine that you can see the numbers of a clock circling around your nipple, at the outer circumference of your areola.

1. Place your right hand on your left breast, with four fingers below your breast and your pinkie finger against your chest wall, place your thumb where the “1” is located on that clock, and the pad of your index finger at the ‘7’ (opposite each other). Partly close your thumb and your index finger together, squeezing your breast slightly, at a position about an inch behind your nipple (about where your areola (the dark circle around your nipple) changes to your regular skin color). You only want to squeeze enough to slightly depress your skin of your breast.

2. Let your pinkie finger drop down out of the way so you can pull your thumb and index finger back toward your chest wall, about an inch (or more if you can), putting pressure against your breast lobules… the glands that are inside your breast (mostly in the back half of your breast, next to your ribs). Your outer breast skin should have come along with your thumb and index finger. Do not let your fingers slide on your skin. Your outer breast skin should stick right with your thumb and index finger through this whole process.

3. When you reach full resistance (you cannot go back any further), squeeze your thumb and index finger closer together to put pressure on your milk ducts that go forward from your lobules to your nipple, deep in the center of your breast. Your comfort should guide you in how much you squeeze. Do not cause pain.

4. Pull your thumb and index finger forward toward your nipple, squeezing as if you were “stripping” the last little bit out of a tube of toothpaste. Do not let your finders SLIDE on your breast skin… make your outer skin move back and forth with your hand and make the inside of your breast skin do the sliding against your milk ducts inside. Stop moving forward when your breast skin gets tight.

5. Slightly release the pressure against the milk ducts by slightly opening your thumb and forefinger, but maintain a slight pressure on your outer breast skin. Repeat steps One through Five half a dozen times. Each full stroke should be about every one to three seconds. You will adjust your time as you become more effective, after you find how the timing affects your output.

6. After about six strokes, move back up to step One, and repeat everything, except place your thumb at the ‘3’ position and your index finger at the ‘9’ position, then go on with steps Two through Five another half-dozen times. Continue doing this, but work your way “around the clock”. Your breast has as many as 25 individual “systems”, each including its own lobules, milk ducts, and ampulla… and nipple opening as well (look closely when milk comes out… there are more then one). As you work around your breast (half a dozen times in each place) you will be working on each of the individual systems. If you do the ‘1’ & ‘7’ position, then the ‘3’ & ‘9’ position, and then the ‘11’ & ‘5’ position, you can go back and start over with the ‘1’ & ‘7’ position again. At least three separate positions should work well for you.

Obviously, you would do the same thing with your right breast, using your left hand. After you get the “hang of it”, you may find that you can do well using your right hand on your right breast (and your left hand on your left breast), which is fine. I only had you use your left on your right so that we were all on the “same page” as I walked you through it. Some even use both hands on one breast at a time, but that may not be satisfactory for you.

For those that are attempting to re-lactate:

You may be asking: “Ok, so I’m doing it… but nothing will come out. What gives?” That is normal. You will most likely see SOMETHING come out, even if it is your first time. Women’s breasts will almost always release some liquid. Breast ducts are living tissue and fluids are always present or the ducts would dry out. That is the reason that the American Cancer Society no longer suggests that you squeeze your nipples during a Breast Self-Examination… you will almost always get something to come out. What they now recommend you to look for when you do a Breast Self-Examination, is to be aware if one or both breasts voluntarily emits liquids (no squeezing). Also, be sure to note whether the liquids are pink or red in color (white, yellow, even green and black are usually ok), or if one breast suddenly emits a fluid with no apparent reason. Obviously, when you are lactating you will get involuntary emission from your nipples, but you will know what that is and why you are getting it.

One thing we know is that you will not be pushing out milk right away, unless you were actively lactating very recently (or if you are on some hormone treatments, including some birth-control methods). What you have to remind yourself of is that you are “training” your breasts. You are also sending signals to your brain to release the proper hormones that will allow your breasts to develop to the point that they will start lactating again. By doing this deep stroking (from-the-back-to-the-front deep stroking), you are causing your breasts to send a signal to your brain and your body to tell them “Hey, we are lactating down here!” It will take days, weeks, and maybe a month or two to get the point across (the more consistent you are with your schedule, the sooner they will get the message), so you just have to keep sending the message and hope that your brain and body hear you … soon.

It is critical that this happens for a long enough time during EACH session (EACH TIME YOU DO MANUAL EXPRESSION) (and on EACH breast), or your brain will not think that you are serious. Always remember that whether your breasts are producing a tiny bit or a whole bunch of milk, if you skip even one session, your brain, body and breasts will all think that you are quitting (weaning your baby), so they will REDUCE the amount of milk they produce the next session or two. Breasts will produce as much as you ask them to produce… enough for two or three babies if you want them to… but they will shut down the MINUTE they can if they think that they are not needed.

It is also very critical that this happens on a REGULAR basis. Our bodies really do love to be extremely punctual. We are true clock-watchers without knowing it. If you express every three hours on Saturday and Sunday, then only do it twice a day through the week, your breasts will figure that you are “weaning your baby” and will reduce the amount of milk they make.

If you are trying to start lactation without the advantage of having delivered a child very recently, I would strongly encourage you to do either oral expression (baby’s mouth on your breast) or manual expression for a minimum of ten to fifteen minutes for EACH BREAST, each session. You will not be getting milk right away, but by continuing this long, you are sending the message of what you are expecting from your breasts. After you are producing some milk (but not for the whole ten or fifteen minutes), continue to do the expressing past the end of your milk, for the full ten to fifteen minutes, so you will have more milk the next few sessions. Your breasts will rise to the occasion. This is how you tell them that you want more then a dribble.

Try to do a session at least every 3-4 hours, 24 hours a day, just the same as you would be doing if you had a brand new baby at your breast and in your home. They ask (should I say DEMAND? LOL ) to be placed at your breast every few hours, morning and night, as you know.

As a little ray of hope here, it will get better. It WILL get BETTER! After you are lactating as much as you want, you can start to cut back a little on the midnight sessions and you may even shorten the sessions somewhat, as long as you monitor your output. Remember, when you cut back on your schedule, your breasts will cut back on their quantity of milk. Also, after you are fully lactating, a good breast pump will do a good job for you, so you do not have to do so much manual expression. Many pumps just do not do a good deep expression like you need to get started, but will do fine after you are in full production.

One benefit of using a breast pump to stimulate your breasts to re-lactate is the fact that it will pump at a rapid rate, stimulating the nerves in your breasts to start lactating. Perhaps adding a little pumping to either end of your manual expression session could be beneficial.

Remember: This Is Not Easy… J …but you have plenty of supporters cheering you on.

Please do not hesitate to ask me to go over any part of this that is not really clear to you. This is something that I can usually do easier by showing someone or talking directly to them as they do it. Writing it down is harder for you and for me, but it WILL WORK… right?

I wish you two the best of success.

Ken L. Smith
Breast Health Facilitator for the American Cancer Society
www.BreastNotes.com
BreastCare@comcast.net

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