Manual Expression of Your Breasts

by Ken L. Smith Breast Health Facilitator for ACS Updated 04/17

If you are currently lactating and want to express your milk manually, this should help you to accomplish that. If you are not lactating and you wish to establish lactation, you can follow the following steps, and even though you will not see milk come out for a while, doing the same steps as often as you would as if you were breastfeeding will help you to reach your goal.

The best method of removing milk from your breasts (or inducing your breasts to re-lactate) is by allowing your infant or partner to suckle with his or her mouth. Your breasts are designed to produce milk when a tongue presses your areolar area (darker pigmented circle surrounding your nipple) up against the roof of their 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, due 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 your using your hands to express your milk from your breasts. A third method is to use 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 breast nerves to encourage them to produce milk. It takes light stroking of your milk ducts (lactiferous ducts that lead from your lobules to your nipple), your ampullae (reservoirs) behind your nipples, and the nerves surrounding your nipples. You can find drawings of the interior of your breast at the following locations:

http://www.breastnotes.com/anatomy/anatomy-inside_of_the_nipple.htm and:

http://www.breastnotes.com/anatomy/anatomy-inside_of_the_breast.htm

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, with the 12 at the center of the upper side of your breast. The 6 is directly below your nipple, and the 3 and the 9 are on opposite sides of your nipple.

Method for Smaller (A-cup through C-cup) Breasts:

1. Lean forward and using both hands very lightly caress and stroke just your left breast from your chest wall to your nipple. Continue this for a dozen strokes, working around your breast to stimulate all segments of lobules inside your breast.
2. Place your left hand on your left breast, with four fingers below your breast and your thumb and your index finger about one inch behind the base of your nipple. Place your thumb where the “12” is located on that imaginary clock (on your breast), and the pad of your index finger at the ‘6’ (opposite each other). Partly close your thumb and your index finger together to the surface of your breast slightly depressing your skin of your breast. This model is using her left hand on her left breast… either hand is fine… whichever is more comfortable for you. Either one will work fine.
3. 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. 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.
4. Squeeze your thumb and index finger closer together to put pressure on your milk ducts, letting your comfort guide you in how much you squeeze. Do not cause pain. 5. 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, behind your nipple.

6. 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, and repeat steps Two through Six half a dozen times. Each full stroke should be about every one to three seconds. You will adjust your timing as you become more effective, after you find how the timing affects your output. 7. After about six strokes, move back up to step Two, and repeat everything, except place your thumb at the ‘9 O'clock’ position and your index finger at the ‘3 O'clock’ position, then go on with steps Three through Six another half-dozen times. Continue repeating steps Three through Six, but work your way “around the clock”. Do the ‘1’ & ‘7’ position, then the ‘10’ & ‘4’ position, and then the ‘11’ & ‘5’ position, and then you can go back and start over with the ‘12’ & ‘6’ position again. At least three separate positions should work well for you. Your breast has as many as 25 individual “systems”, each including its own lobules, milk ducts, and an ampulla… and nipple opening as well (look closely when milk comes out… there are more then one duct opening in your nipple). As you work around your breast (half a dozen times in each place) you will be working on each of the individual systems. 8. Obviously, you would do the same thing with your right breast, using your other hand. After you get the “hang of it”, you may find that you can do well using your right hand on your left breast (and your left hand on your right breast), which is fine. Whatever is comfortable for you in your situation. Some even use both hands on one breast at a time, but that may not be satisfactory for you. 9. If you are stimulating your breasts to induce lactation, continue working with each breast for a full ten to fifteen minutes, and then move to your other breast and do it for the same amount of time. If you are already lactating and using Manual Expression to express your milk, continue until your breasts are empty of milk. Leaving milk in your breast will cause your breasts to produce less milk at later expression sessions. It will also increase your risk of developing mastitis in your breasts and you do not want that.

Alternate Method for Larger Breasts:

It may be quite difficult for you to do manual expression with breasts that are a large D-cup or larger. You may have more success with the following procedure.

1. Lean forward and using both hands very lightly caress and stroke your left breast from your chest wall to your nipple. Continue this for a dozen strokes, working around your breast to stimulate all segments of lobules inside your breast.

2. Using both hands, close your hands around your left breast, with your thumbs and forefingers placed about 1 1/2 inches behind your nipple, slightly depressing the skin of your breast.

3. Maintain that pressure and move forward, stroking the inner tissues, stopping behind your nipple.

4. Slightly release your grip and move your hands back to step Two and repeat steps Two through Four.

5. Return and repeat steps Two through Four.

6. Do this at a rate of about 16 times a minute. Everything else is the same as for smaller breasts.

General Notes:

If you find that it works better for you to use some lubricant on your hands, any body lubricant would work fine. Body oils, massage oils, Pure Cornstarch baby powder, soap if you are in the tub or shower, chocolate pudding (if you feel really decadent). You can always let your partner help of course

You are massaging your breasts and stimulating nerves deep inside your breasts. The more important ones are just behind your nipple, so be sure to complete each stroke to the base of your nipple. Do not stroke the nipple. That works only on cows and goats. Human nipples are only passages.

Your glands and nerves in your breasts radiate out from your nipple in all directions, like the “minute marks” on the face of a clock. Rotate your hands a little to begin the next series of half a dozen strokes, so that you are stimulating a different bunch of glands and nerves every so often.

Actually, every woman should be doing some type of breast massage for ten minutes every day of their lives, starting from the age that they first have breast development. Your breasts have the least amount of blood vessels per cubic inch of body mass than any other part of your body. That means you have very limited circulation in your breasts to carry away the toxins and waste products from all of those body cells in your breasts. That is thought to be part of the reason breast cancer is so prevalent today. Your breasts compensate for this limited blood circulation by having the GREATEST amount of lymphatic fluid vessels per cubic inch of body mass than any other part of your body. Lymphatic fluids do not have a heart to make them flow and they can only flow when your breasts move and swing, as they naturally do when you do not wear a bra. Since our world wants us to wear bras, we can compensate somewhat by doing some type of breast massage every day and keeping the total hours per day that you wear your bra to a minimum. Pure lymphatic massage (not attempting lactation) only needs very light pressures.

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?” If you are attempting to re-lactate, then 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 that you look for when you do a Breast Self-Examination, is to be aware if one or both breasts voluntarily emits liquids (without any 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 has lately started to emit a fluid for 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 and developing new glandular tissues. You are also sending nerve 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 stroking behind your nipples you are causing your breasts to send a signal to your brain and your body to tell them “Hey, we are requesting milk down here!” It will usually take a few months or so to get the point across (the more consistent you are with your schedule, the earlier they will get the message), so you just have to keep sending the message and hope that your brain and body ‘hears’ you … soon.

It is critical that this manually expressing your breasts continues happening 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 for 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. Skipping a session before you are producing milk may basically set back your progress toward reaching lactation for the next four sessions or so.

It is also very critical that these sessions happen 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 recently, I would strongly encourage you to do either oral expression (baby’s or partner’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 "dry" nursing or expression, you are sending the message of what you are expecting from your breasts. After you are producing some milk for a few minutes of the session, continue to do the expressing past the end of your milk, for the full ten to fifteen minutes, so you will have more milk after 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. Those babies ask (should I say DEMAND?) 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. 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. You are no longer “training” your breasts to lactate… they are already there. Many pumps just do not do a good nerve stimulation like you need to get started, but will serve you 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, similar to the rate a newborn babe would use, stimulating the nerves in your breasts to start lactating. Often, adding five minutes of pumping after your session of 10 – 15 minutes of manual expression (until you reach your anticipated production level) could be beneficial.

Looking at a video would be helpful, and we have two available for you to study. You can visit them by clicking on these two links. When you finish, hit your "back" button or your "<" key to return to this location.

In this first video, our model shows how she expresses her breasts in the "12 and 6" position, first with her right breast, and then with her left breast. Compare how she is doing it with how you do it, to see if you are doing it correctly. Because the video is short, she only does each breast for 15 seconds. In your case, you should express each breast the full ten or fifteen minutes, and then move to your other breast for the full ten or fifteen minutes. Of course, you CAN express both breasts at the same time if you care to do that.

https://youtu.be/oOCBebjYHWo

In the second video, the same model shows how she changes from the "12 and 6" position to other positions, to allow other segments or her breasts to be stimulated. She switches around rather frequently, to show you the various positions, but you should stick with each position for at least half a dozen expressions, and then move to another position.

https://youtu.be/mKmsKbt694s

You can see that she does her left breast in the "2 and 8" position, then she moves to the "3 and 9" position, and then to the "4 and 10" position. The idea is to move completely around each breast, like the hands of the clock. Your breast sectors or lobules are arranged completely around your nipples. You want to stimulate each one of them.

Remember that establishing lactation Is Not Easy, but you have plenty of supporters cheering you on.

Please do not hesitate to ask Ken to go over any part of this that is not really clear to you. Or contact him by e-mail if you have questions or wish assistance. His email is BreastCare@comcast.net.