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Subject:
From:
"Kermaline J. Cotterman" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 25 Feb 2004 14:55:44 -0500
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Chrissa,

My comment is that it seems to me the answer to the question you posed
depends as much (or more) on the pre-op physical status of the individual
breast as it does on the surgery, placement of incision, etc. itself.
There is currently, to my knowledge, no accurate way to assess whether
there is insufficient glandular tissue in a resting breast, to begin
with. Though the basic ductal structure is laid down in the embryonic and
fetal period, most of the lobular development takes place later. The
young adolescent nullipara has about 90% fatty and connective tissue in
the breast. (The advertising and entertainment worlds don't breathe a
word of that!)

Full breast development, with fat being gradually evacuated from the
breast to make room for the budding and increase of alveoli,  is only
stimulated by repeated menstrual cycles and much moreso, by pregnancy and
lactation, after which alveoli largely involute following weaning, (like
the leaves of a tree fall in autumn.) If weaning is gradual,
re-importation of fat occurs gradually, only to again move out for
re-budding mostly new alveoli with the new placental stimulation of a
subsequent pregnancy (like new leaves on a tree in spring.)

Elective breast surgery would occur on a "resting breast, either before
this sequence or between pregnancies, so in an unknown number of cases,
there may be predisposing factors for insufficient milk supply before
surgery is ever contemplated. There have been cases discussed on LN
within the past 2 months of mothers who had signs suggestive of
insufficient glandular tissue, such as a wide distance between breasts,
or frank tubular breasts, with subsequent difficulty in bringing in an
adequate supply despite pumping, domperidone, frequent nursing with
supplementers, etc. So the impossibility of objectively defining the
number of lobes, etc. in the breast, before augmentation itself takes
place, would enter into the equation long before the mother elects a
cosmetic procedure for subjective social and psychological reasons.

Perhaps we as LC's, physicians and nurses should be asking the mother
more about the what actual shape and size characteristics of  her breast
were before augmentation (perhaps using for comparison pictures from
articles and textbooks, such as "The Breastfeeding Atlas" by Wilson-Clay
and Hoover)., to have a better idea of how her genetically endowed
equipment may have placed her at risk of insufficient supply even without
surgery.

"This complex organ therefore has to be described in its anatomy,
histology, ultrastructure, physiology, or response to hormones not as a
static picture, but as a dynamic phenomenon in which each phase is
transitory and heavily dependent on the age at which it is studied, and
the specific conditions of the host . . . the development of the mammary
gland has to be evaluated based on the architecture of the organ at each
given period of time for each individual woman."

Russo J, Russo IH Development of the Human Mammary Gland in: The Mammary
Gland, Development, Regulation, and Function ed. by Neville MC, Daniels
CW 1987 Plenum Press, NY. pp. 67-93.

This book chapter is based on dissection and study of 114 surgical or
autopsy breasts specimens, and contains an interesting set of pie-charts
and other graphic representations of differing amounts of various types
of tissue depending on age/parity (though I might add, there is no
mention of lactation history as a variable.)

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

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