Ann writes: <This is just my theory based on observation and some on the science of how our lymphatic system works. Women with smaller breast are more likely to exhibit more noticeable primary engorgement than women with very large breast. The smaller breast has less adipose tissue and the milk glands are closer to the surface, therefore there is less tissue space to expand with the filling from the lymphatic system.> I do remember empirical advice I gave to small breasted moms in my prenatal BrF class teaching days. I emphasized that they would be wise to feed early and massage from the chest wall forward early and frequently, before and between feedings, to help keep the milk moving forward so it wouldn't crowd the back of the breast where more milk was being made. That's long before I began to read extensively about the embryology and anatomy of the breast. So I must have been in agreement with you then. Now, I am seeing it in a different way. One source describes the breast as a "cutaneous envelope" (an envelope of skin) containing different kinds and amounts of tissue at different times in life. It changes during each menstrual cycle. There is sometimes edema in the connective during one part of the cycle, at least in younger women. This may be causing the skin to expand slowly as the breast develops. I also read that that is one of the primary reasons for fat tissue in breasts-to "hold the space", and maintain the architecture in the growing gland, so that during pregnancy, the fat can be metabolically taken out of the breast as the glandular tissue grows. In one study, at term, the glandular tissue had grown to occupy >70% of the space, while the amount of connective tissue (including fat cells) was reduced to <30%. If so, then the woman with the small breast might be one who hasn't much fatty tissue but has a "standard" amount of glandular tissue (in other words, we're not talking here about glandular insufficiency). I want to introduce a simple garden metaphor here that helped me to make sense of the embryonic references I read: Plant . . . . . . is to Soil as Parenchyma is to Stroma. Visualize the roots of a Plant growing down into the Soil. Then visualize the ectodermal layer (the parenchyma [the future glandular tissue] of the breast) budding and sprouting "roots" downward into the mesodermal layer (the stroma [future connective tissue, including the lymphatic system] of the breast. I was fascinated to read that during embryonic development, the mesoderm is essential to developing the pathways through which the ectoderm then grows. Without it, the parenchyma doesn't grow. (Good soil conditions needed for healthy plants.) Therefore my logic tells me that the mother with a "standard" amount of glandular tissue would first have to have developed a "standard" amount of connective (including lymphatic) tissue too. If she experiences swelling within the glandular compartment, that might expand her skin tightly if there had been little fat there in the first place. But once again, if we are talking about swelling within the glandular tree, we're dealing with something that comes from delayed or inefficient milk removal. And that causes a "traffic jam" especially in the upper outer quadrant. And this competes for available space that the lymph vessels need for efficient drainage. And if this mom had lots of IV fluid, plus perhaps pitocin, then she will also get an abnormal amount of tissue fluid built up in the connective tissue, making it difficult for even an "uncrowded" lymphatic pump to remove rapidly enough. So early, regular MER's, efficient latching and frequent efficient suckling, with breast compression, or massage or fingertip expression if needed to keep the milk moving, is the primary way to prevent back-up inside the glandular tree. Efficient drainage of the glandular tree will prevent physical blockage of the lymphatic pathways. But steady entry of tissue fluid into the lymphatic pump might not be able to keep up with rapid formation of excess tissue fluid, depending on the amount of IV fluid given. (Tissue fluid enters from the circulatory capillaries, and is not officially defined as "lymph" till it enters a lymphatic vessel.) The volume of IV fluids given has heretofore been a missing part of the engorgement research equation. Likewise, the # of units of pitocin, which can have antidiuretic properties. It seems to me that there is enough evidence out there now to label these as important variables. No articles on engorgement that I have yet seen have taken these measured factors into consideration. I'd appreciate learning about them if anyone can provide such references. <Women with large breast describe increase heaviness in their breast but I rarely find them with severe engorgement compared to women with the smaller breast.> Engorgement has been defined and described in a lot of different ways. One way was to measure the actual "hardness" of the breast with an electronic instrument. It sounds as if "hardness" is how you are "measuring" comparative engorgement. I would think that one where the skin was stretched to it's limit would also feel more painful, a way that other engorgement research measured degrees of engorgement. So I can see how a larger breast might still have enough space once the fat cushion was reduced, so that the skin might not be as stretched, might not feel as hard, or as painful, even with the same degree of fullness of the glandular tree and the same conditions effecting formation and removal of tissue fluid through the lymphatic pump. <Where I find this dilemma more challenging is in the areola. In the smaller breast the areola gets much firmer during engorgement than the larger breast and therefore babies refusing to latch on day 4 when they were doing fine in the hospital.> We are all familiar with watching balloons expand, and I think it provides a good model here. When you blow up a small balloon, the tip disappears more quickly than when you blow up a larger balloon with the same amount of air. And the small balloon feels firmer, because it has less surface area, and therefore is stretched more tightly, to contain the same volume of air. I believe excess subareolar tissue resistance is an unidentified piece in the puzzle of poor latch, ineffective suckling and nipple pain and damage. And although I'll agree it's probably seen more often in women with smaller size breasts, I'm not certain the larger breasted mom escapes it. What you have described as the firmness of the areola interfering with latching has been the basis for my thinking in developing the concept of Reverse Pressure Softening. See http://health-e-learning.com and click on "Research Articles". Jean **************** K. Jean Cotterman RNC, RLC, IBCLC Dayton, OH *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. 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