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Subject:
From:
Kathleen Huggins <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 1 Mar 2000 09:57:09 -0800
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Hello All!  I read with great interest Gonneke's recent study about stretch
marks.  I am happy to see a baseline study to determine of the frequency of
breast stretch marks in the general population of nursing mothers.

As one of the researchers of this study, I would like to discuss our
findings and my thoughts about this particular finding.  I noticed before
our study that many mothers with breast hypoplasia had stretch marks.  I
was surprised to see this. This really caught my attention because these
breasts are typically small and rather underdeveloped.  (In contrast my
buttocks is not!) In fact, the mothers whose breasts we categorized as Type
2, 3 or 4, have an incidence of stretch marks that is quite high, at least
66%.  So to see a population of mothers who produced milk as expected with
stretch marks at 47% is an interesting comparison to our group.

I wondered if there was such a high percentage of mothers with stretch
marks because the growth of the hypoplastic breast is abnormal.  It appears
to me that most of the growth is restricted to mainly one direction.  In
fact, one group of plastic surgeons in the literature believe that these
breasts are restricted in growth because of a tight band at the base of the
breast.  We saw an even higher rate of stretch marks with those mothers who
had marked breast asymmetry.

I do hope that no one thinks that we see stretch marks alone as a marker
for insufficient lactation.  In fact, I do not think that any one of the
characteristics that we looked at alone is a marker for insufficient
lactation.  We do think that having hypoplastic breasts with or without any
of these characteristics does place a mother at higher risk for inadequate
production.

It is our hope that all mothers with breasts appearing hypoplastic will be
identified in pregnancy or at least in the immediate post partum period so
that they can be closely monitored and excessive weight loss and other
associated complications can be prevented.  Sometimes we are wrong (not
very often) and the milk comes flooding in at three days but we rarely miss
any of these moms who deliver in our facility.  In fact, our OB nurses are
quick to point them out to us.

I have followed with interest the discussion about talking about this with
mothers.  I can say from experience, that nothing is more difficult than
facing a mother with severe hypoplasia at 24 hours post partum and deciding
how to present our concerns.  At this time, we tell them that from our
experience, mothers with little or no breast growth in pregnancy and widely
spaced breasts, may have late onset of milk production.  For this reason,
we ask to see them back in our out patient clinic at 72-96 hours post
partum.

We do the same thing with other mothers who in our experience are at higher
risk for inadequate milk intake like mothers who have had previous breast
surgery involving an incision around the areola, babies with poor muscle
tone, and babies who are born at 37 weeks gestation or less, and mothers
with large nipples (as large or larger than a quarter).

Kathleen Huggins

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