Milk Production & Breast Anatomy (139-146)

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Cooper's Ligaments

suspensory ligaments; fibrous bands extending from the inner breast surface to the chest wall muscles. They run vertically, attaching to the deep layer of subcutaneous tissue to the dermis layer of the skin.

Hypoplasia

the incomplete development of an organ or tissue. Tubular shape, may have large aerolas, frequently asymmetrical and widely spaced. Increased risk for insuifficient milk production.

Something is responsible for stimulating another gland

Define Trophic

Breast maturation during puberty. pituitary gonadotropins raise estrogen levels resulting in more ducts, fat, and appearance of lobules.

Describe the main components of the process of Thelarche

Mammogenesis at 4-5 Weeks

Development begins. Milk lines develop (aka galactic streak/mammary ridge)

Lactogenesis 1 process

Differentiation occurs of alveolar epithelial cells into lactocytes that secrete colostrum. Lactose, total proteins, and immunoglobulin increase. Sodium and chloride decrease. Nutrients from bloodstream go towards preparing to breastfeed.

Montgomery glands

Milk and sebaceous oil glands present on the aerola. They contribute to breastfeeding, early grwoth and lactogenesis. Helps newborns find the breast and creates lubrication.

Milk Expulsion Process

Oxytocin commands myoepithelial cells to begin contracting and pushing milk out of the alveoli into the ducts, onto the nipple. The more oxytocin is released, the more the hypothalamus is told to increase prolactin and oxytocin production.

Stroma

Supporting tissue of the breast including the connective tissue, fat tissue, blood vessels, nerves and lymphatics

True

T or F: Breast size can decrease between 6-9 months postpartum

False

T or F: Breast size has an impact on milk production capacity.

Adipose tissue

Fat surrounding the glandular tissue to provide protection and warmth to the mammary structures

True

T or F: Exclusive breastfeeding mothers have a higher level of oxytocin than those that mix feed

Lactogenesis 1 definition

First stage of lactation beginning around mid-pregnancy until day 2ish postpartum. Driven by hormones and radically changing the appearance of the aerola/breast.

False

T or F: First time moms usually have high protractility of full extension to junction of the newborn's hard/soft palate

False

T or F: Nipple types plays a part in the ease and effectiveness of breastfeeding

True

T or F: Oxytocin levels rise and fall within the minutes starting and ending a feed, with suckling and skin to skin

False

T or F: Prolactin levels are lower during the day than at night

True

T or F: What matters in effectiveness in breastfeeding is how flexible the aerola and nipple tissue is and how much a deep latch can be attained.

True

T or F: Women with more montgomery glands have babies with more weight gain than those with fewer

Hypertrophy

Abnormally large breast (gigantomastia)

Hypomastia

Abnormally small breast

Flat nipple

Absence of the nipple shaft that may be soft and pliable. Can be able to form ridge to allow for baby to latch. May remain unchanged when stimulated, or even retract when compressed.

Left and right refers to mother's point of view. Upper & lower outer and inner quadrants

Breast Quadrants

Lactogenesis 4

Breast returns to non-productive state and breast milk sodium levels increase.

Nipple Aerola Complex (NAC)

A round structure cromprised of muscle fibers on the breast, about 3-6 cm long and usually positioned about 4th rib level.

Nipple (Mammary pipilla)

At the center of the aerola, on average 10-12 mm and height of 9-10 mm. Lined with 10-20 pores leading to interior lactation anatomy providing a path to secrete out of the breast.

FIL- Feedback Inhibitor of Lactation

Autocrin mechanism of lactation not fully understood yet. When breasts stay full, FIL isn't removed, reducing milk production.

17-33 ml/hr

Average rate of milk production

Lobes

Clusters of lubules filled with alveoli.

Amastia

Congenital absence of the breast tissue and the nipple. One breast gone points to Poland's syndrome.

10-100

Each breast contains how many alveoli?

15-25

Each breast contains how many lobes?

Tail of Spence

Extension of the mammary tissue into the armpit, which may become full of milk and engorge for some women

Polymastia

Extra breast tissue

Hyperthelia

Extra nipple without any accompanying mammary tissue

Polythelia

Extra nipples with mammary tissue

Estrogen

Growth hormone that causes ductal system proliferation nd differentiation and the growth of connective tissue between the ducts. Produced by the ovaries, adrenals, and fat tissue.

Oxytocin

Hormone responsible for muscle contraction of alveoli. Produced in the posterior pituitary.

Prolactin

Hormone responsible for nipple and areolar growth, stimulates mammary secretory epithelial cells to produce milk. Produced in the anterior pituitary. Essential for initiation and maintenance in milk production.

Oxytocin release

Hormone responsible for the milk ejection reflex by contracting the myoepithelial cells around the alveoli

Progesterone

Hormone that increases the size of the lobes, lobules and alveoli. Produced by the ovaries, placenta and adrenal glands.

Progesterone

Hormone that stimulates the growth of alveoli

Both hormones are together only for a short time after birth. They promote bonding and nesting and the 5 senses increase production.

How do estrogen and oxytocin work together?

Rise directly following birth, then rise/fall shortly thereafter based on frequency and intensity of nipple stim

How do prolactin levels differ during pregnancy and postpartum?

May increase with breastfeeding and additional lactation experiences. More stretching and more movement = more increasing of comfort over time.

How does protractility change over time?

A week

How long does it take prolactin to return to non-pregnant levels if a woman doesn't breastfeed?

Breast Type 3

Hypoplasia of the lower medial and lateral quadrants

Breast Type 2

Hypoplasia of the lower medial quadrants

Relief for engorgment of the tail of spence

Ice packs and green cabbage

Serotonin (a neurotransmitter) believed to help regulate mood, appetite, digestion, sleep, memory, sexual desire and function

In theory, what is FIL really hypothesized to be?

Higher concentration and less milk production

Less stimulation and milk removal leads to higher or lower PIF concentration? and higher or lower milk production?

Lactogenesis 3 definition

Maintenance of milk production from day 9 on. Also known as galactopoiesis.

Pseudo-inverted or dimpled nipple

May appear inverted, but everts with compression or stimulation

Lactocytes

Milk making cells lining the interior of each alveolus

Milk Ejection/Letdown reflex

Milk releasing from the breast in response to stimulation. Nipple stimulation releases prolactin and oxytocin, and the process becomes conditioned over time- meaning just thinking about the baby will initiate it

Lower concentration and higher milk production

More stimulation and milk removal leads to what concentration of PIF and level of milk production?

Retracted Nipple

Most common type of nipple inversion. Appears everted, but retracts with stimulation.

Myoepithelial cells

Muscle fibers that surround the outside of the alveoli, aiding in milk contraction

Amazia

Nipple and aerola without breast tissue

Mammogenesis at 12-16 Weeks

Nipple and areola formation. Epithelial cells develop into buds and epithelial branches form

Highly vascularized secretory cells extract water, amino acids, fats, vitamins and minerals and other substances from blood

On a chemical level, how is milk made?

Hyperplasia

Overdevelopment of breast

Lactiferous ductules

Passageways for the milk formed in a branched network much like branches of a tree. Milk is moved from the alveoli into ductules joining into the ducts towards the nipple.

Mammogenesis at puberty

Primary & secondary duct growth continues with each menstrual cycle.. Estrogen, steroids and growth hormones affect the ducts.

Establishes milk synthesis

Prolactin does what in lactogenesis 3?

200-400 ng/ml

Prolactin levels rise during pregnancy from 10-20 ng/ml to what at term?

Prolactin receptor theory

Prolactin receptors in the basement membrane of alveoli where lactocytes are attached. Milk accumulates and the shape of the lactocyte is distorted. Prolactin can't bind to the receptor, down-regulating the rate of milk production.

TSH (Thyroid stimulating hormone)

Promotes mammary growth and lactation. Hypothyroidism can contribute to low milk production.

Common Nipple

Protrudes at rest and becomes erect with stimulation

Lymphatics

Referring to most drainage in the breast, including immunity bearers and primary axillary

Breast Type 1

Round tissue and fullness of all quadrants

Breast Type 4

Severe hypoplasia, minimal breast tissue

Mammogenesis at 15-25 Weeks

Shallow epithelial depressions. Mammary pits begin to form, if not, inverted nipples result

Visual signs of lactogenesis 1

Skin appears thinner, veins more prominent, diameter of areola increases, nipples more erect, color of aerola darkens, montgomery glands enlarge.

Prolactin-inhibiting factor (PIF)

Stimulates dopamine release which inhibits prolactin release. Nipple stimulation and milk removal suppresses PIF, as well as other medications.

Cortisol

Stress hormone that may delay lactogenesis 2 if extremely present in high amounts

Lumen

The hollow storage space for milk inside of the alveolus once created.

60%

The internal mammary artery supplies how much blood to the breast?

30%

The lateral thoracic artery provides 30% of blood to the breast?

The more milk is made!

The more milk that leaves the breast...

Lactogenesis 2 process

The onset of copious milk secretion, then it begins to level off. First, engorgement occurs as supply arrives. There's a decrease in sodium, chloride and protein in milk due to closure of gaps between cells. Milk increases in lactose and milk lipids.

Lactogenesis

The process of lactation!

Lactogenesis 2 definition

The secretory activation process in lactation beginning approximately day 2 to day 8 postpartum

Alveoli

Tiny sacs of the mature mammary gland lined with lactocytes (epithelial cells). Where milk production occurs. They consist of epithelial cells encased in a dense network of myoepithelial cells.

Inverted Nipple

True inversion of the nipple at rest and with stimulation. Adhesions may be present on the skin folds.

Poland syndrome

Unilateral breast hypoplasia with hypoplasia of the thorax and pectoral muscles

Placenta removal

What causes the rapid drop of progesterone, triggering lactogenesis stage 2?

Suppress milk production

What do high levels of estrogen do?

Causes milk ejection, reduces stress, causes uterine contractions, establishes caring and bonding behaviors

What does oxytocin do in lactogenesis 3?

Illness, chemo, radiation, injury or surgery to the chest

What effects breast development and may cause anomolies?

Prolactin

What hormone can delay ovulation?

Progesterone during pregnancy

What hormone inhibits lactation during pregnancy since it interferes with prolactin at the receptor level?

Oxytocin

What hormone spikes to contract the uterus, controlling postpartum bleeding and helping uterine ivolution?

Estrogen, progesterone, adrenals, and pituitaries

What hormones control the cell division process during puberty and thelarche?

Growth of ducts and lobuloalveolar (ducts and segments) systems in the breast

What is responsible for the growth of the breasts during pregnancy?

Endocrine to autocrine supply

What kind of supply switch happens in lactogenesis 2?

16-20 weeks gestation, even if the pregnancy terminates

When is colostrum first produced during pregnancy?

4th Nerve

Which nerve supplies the largest amount of sensation to the nipple and aerola?

ACTH (adrenocorticotropic hormone)

Works with prolactin and progesterone to promote mammary growth


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