Frequent breastfeeding during the first 6 weeks postpartum seems to
increase the number of prolactin receptors on milk gland cells, so that
when the baseline prolactin level drops, there is still enough to get
into the cells and "turn up" the machinery when prolactin spurts occur
from suckling.
        In reduction mammoplasty, glandular tissue is removed along with the
adipose (fat) tissue.  Possibly the glandular tissue that remains is
reduced in quantity and needs hyperstimulation to meet the demand for
milk.  This could explain why some moms who have had reductions do not
make enough milk without prolactin elevating drugs like domperidone.
        As for ethanol in milk:  the reason the milk in the breast becomes safe
is that the ethanol level in milk and blood are in equilibrium because
ethanol passes freely to and from the milk.  As the body metabolizes the
ethanol in the blood, the blood level decreases, causing a concentration
gradient favoring passage of the alcohol from the milk to the
bloodstream.  This dynamic could not occur if the milk were expressed.
Therefore, letting milk sit will not cause the ethanol to degrade or
disappear.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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