This has been a perplexing issue. I, too, have seen milk supplies reduced
after mastitis or some other complication that just seem to refuse to
come back. I can't recall the source at the moment, but in the past
couple of years there has been some discussion on what happens when
breasts overfill. The first part, of course, is that the pressure
triggers a reduction or shut-down of milk production. After this comes
destruction of the "unneeded" alveoli, atrophy. The discussion originated
on the topic of extreme engorgement and the possibility that, not treated
quickly, severe engorgement could lead to permanently reduced milk supplies.

Now add to this another facet: when induced lactation has been studied,
it has been found that a mother currently nursing a toddler does not seem
to have an advantage in bringing in a milk supply for a new baby. The
only "advantage" documented thus far is that a woman who has experienced
previous pregnancy/lactation has an advantage over a woman who has
never been pregnant; between the woman who has been pregnant and the one
currently lactating with an older child, however, there is no advantage.
Why?

We know that the non-pregnant, non-lactating breast is a like a tree in
the winter with no leaves, just stark branches. During pregnancy, the
breast "leafs out" like a tree in spring, until it blossoms and bears
fruit (baby is born and mother lactates). Perhaps the weaning down period
is like entering autumn, and at some point the leaves are no longer
renewable for the season; the tree must enter dormancy before it can
bloom again.

The missing piece of info here is: in these cases of mastitis, were plugs
and/or engorgement part of the problem? Lack of milk flow, lack of
drainage? Did some of these cells simply die off?  I would extrapolate
that some mothers have more than enough cells and can afford to lose
some, while for other mothers any loss can be a compromising and
significant one.  I would be interested in what others think of this idea.

-Lisa

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Lisa Marasco, BA, LLLL, IBCLC
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