Christine writes:

<Hello. I am working with a mom that had a hospital acquired staph infection
in her right breast soon after birth. She got it from her mom who had a
staph infection after her c/s. This was 27 years ago and I am repeating what
mom told me. The infection was serious and it required drains and such. . .
. . . .  For those that really understand the anatomy of the breast could
you explain what may have happened to the milk ducts? >

My guess is that there may well have been some scar tissue resulting, both
from the inflammation of the infection and the interruption of some ducts
from the "stab" incision necessary to place the drain deep enough to do its
job, especially since the total area was so small. OTOH, since the area was
so small at that stage of development, perhaps the drain stab occurred
outside the actual breast tissue itself. Just happen to have a book out of
the health sciences library this week "researching" one of my favorite
subjects - - embryology and microscopic photography of the tissues of the
nipple-areolar complex. (It's almost like a hobby for me;-)

Saner, FD, ed., The Breast: Structure: Function: Disease, Williams and
Wilkins, Baltimore, 1950.

Much regarding function and disease is of course outdated by all the new
research done since. However, I like such books because they frequently
contain the actual pictures of the microscopic views of tissues, whereas
many new books simply quote what they want from the folks who actually did
the looking under the microscope. In this book, they still quote what other
researchers found, but that seems to me to be closer to "first generation"
investigation than some of today's books, which often condense and leave
many things out in a "synopsis" in order to simplify.

My understanding of many of the terms is very simplistic, but this quote
demonstrates that the breast is still actively developing its basic initial
ductal and nipple anatomy right at the newborn period, with the canalization
having been fairly recently completed before birth.

"During the 8th and still more in the 9th fetal months there is great
activity of the ducts, which grow and branch, and the increase in the total
amount of epithelium is very striking. The cells enlarge and appear slightly
swollen, in marked contrast with the compact cells of the sweat-glands at
this stage . . . . . At birth the nipple area is still depressed below the
surface and shows a typical stratified squamous epithelium (my comment: this
is the type of cells that cover the outside surface of our skin) The
definitive number of milk ducts is present, and canalization through the
nipple is complete; some branching of the ducts has occurred but no lobules
have formed . . . .At birth-The glands have the same structure in both
sexes. The whole mass is less than 1 cm in diameter, and is surrounded by
connective tissue that blends with the dermal and subdermal tissue: the
nipple is not elevated. . . . the bulk of the organ consists of dense
interlobar connective tissue; the collagen fibers are thick, there are many
elastic fibers,  . . . .The interlobular or periductal connective tissue,
between the groups of ducts and their branches is considerably less dense
and more cellular: there are numerous fine elastic fibers. The small
collections of lymphocytes commonly found near the growing ducts are the
usual response to the presence of degenerating epithelial cells, in this
case associated with canalization."

I think I remember reading elsewhere of ducts interrupted surgically during
adulthood where some recanalization of the interrupted ducts sometimes can
take place.
Whether that would be true in the early stages or not is probably a
combination of chance and guesswork. I think it stands to reason that even
though the alveoli were not formed until puberty and pregnancy, however much
the volume of milk that is actually produced in that breast, the less milk
that is removed,(e.g. the more milk that stays in the breast) the sooner
feedback inhibition would reduce the amount produced, and the sooner
involution would begin to take place in that breast. That certainly doesn't
mean that she couldn't continue to use that breast for non-nutritive
sucking, or for supplementation, (with EBM from the other side if
possible) at that breast if mother and baby so desire. Frequent drainage of
the unaffected breast, by feeding and/or pumping if need be, should
theoretically cause it to produce what the baby needs, just as it might be
called upon to do if this were a multiple birth.

Jean
***************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA

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