Margaret,

The way I understand it, until the breasts involute, they are still
producing milk and are therefore still considered "active," whether the
baby is breastfeeding or the mother is pumping.  According to what I've
read, it takes about four weeks after full weaning for the breasts to
involute.  That's why weaning "at least several weeks" before a treatment
dose is recommended.  If the mother's breasts have not yet involuted and
are still active when she goes for treatment, the radiation will be drawn
to the breasts, increasing her exposure and putting her at increased risk
for breast cancer.

In the newest Hale (p. 422) he writes, "In a study by Hammami, radioactive
I-131 was found to transfer into breasts weeks following cessation of
lactation.  They suggest the breast is a 'radioactive reservoir.'"

Bakheer, S. and Hammami, M. Patterns of radioiodine uptake by the
lactating breast.  Eur J Nucl Med 1994; 21(7):604-08.

If continuing production for an extra week means that she will not have
fully involuted by the time of the treatment, it adds to her risk.  But
this is a difficult decision that only she can make.

Hope this helps,

Nancy Mohrbacher, IBCLC
Lactation Education Specialist, Hollister, Inc.




To
avoid active transport of iodine into the breast, we're preceding the
treatment with two weeks of weaning, followed by four weeks to allow for
involution of milk-producing tissue (in line with Nancy Mohrbacher's
reference to "several weeks" for the process).

Is allowing two weeks unnecessarily generous for weaning? The mother is
just pumping, so the baby's reaction isn't in the equation.  Could she
continue production for an extra week, and assume we can stop the flow
in one unpleasant week, maybe with some sudafed, mint, sage, cabbage,
etc.  (Perhaps continuing production for an extra week means more to me
than to this mother, who is focused on just getting past this treatment
and being there for her daughter.)  Granted, there's a huge range of
individual differences, but I'd love to hear other experiences on how
quickly an abrupt weaning will take hold (at least to the first stage of
not filling up.)

My other question is more generally about the cessation of breastfeeding
and the programmed cell-death of the alveoli -- what's the process
behind some women's ability to express a few drops of milk long after
weaning? How can we say that someone is "dried up."?  This relates
somewhat to Lisa Marasco's current thread about how relactation or
induced lactation might be affected by the mother's history.  How much
functional tissue hangs around after weaning?




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