Anatomia y fisiologia de la lactancia. Vera May

Development of Mammary Glands in Infants

Intrauterine Development

• Both male and female infants have mammary gland precursors formed during the early weeks of intrauterine life. This is surprising but true for both genders.

• Female infants may experience a small amount of milk secretion at birth due to maternal hormones acting on these embryonic glands, historically referred to as "witch's milk."

Postnatal Changes

• After birth, mammary glands remain inactive; some infants may show swollen glands or slightly enlarged nipples, which should not be manipulated or treated with heat/cold. This condition will resolve naturally under pediatric supervision.

Puberty and Hormonal Influence on Breast Development

Hormonal Regulation

• During puberty, breast development occurs due to estrogen and progesterone, leading to increased volume and tissue growth until the establishment of the menstrual cycle. The cycle alternates between phases dominated by estrogen and progesterone every 15 days.

Menstrual Cycle Impact

• The mammary gland undergoes changes influenced by hormonal fluctuations throughout the menstrual cycle, including potential discomfort (mastodynia) in some girls without significant issues overall.

Pregnancy Effects on Mammary Glands

Early Pregnancy Symptoms

• Early pregnancy symptoms often include breast tenderness and fullness due to implantation hormones before other physical signs appear. These changes are most pronounced in the first trimester.

Postpartum Hormonal Shifts

• After childbirth, there is a sharp decline in progesterone levels as placental hormones exit the body, triggering prolactin production that initiates milk synthesis within days post-delivery. Initial secretions include colostrum followed by transitional milk around day 3–10 postpartum.

Anatomy of Milk Production

Structure of Mammary Glands

• The mammary gland consists of small alveoli resembling grapes or cauliflower heads surrounded by blood vessels and muscle fibers that help expel milk through ducts into nipple pores when stimulated by oxytocin during breastfeeding.

Misconceptions about Lactiferous Sinuses

• Recent discoveries indicate that what were thought to be lactiferous sinuses are actually dilated sections of ducts filled with milk rather than separate storage areas for it; this highlights how important proper latch techniques are for effective breastfeeding.

Hormonal Control Over Lactation

Role of Prolactin and Oxytocin

• Prolactin is responsible for milk production while oxytocin facilitates its ejection from alveoli during breastfeeding; both hormones are regulated by the hypothalamus-pituitary axis which can be affected by stress or emotional states impacting lactation efficiency.

Factors Influencing Milk Production

• Approximately 80% of milk production occurs while the baby suckles; even thoughts about the baby can stimulate hormone release enhancing lactation response significantly within minutes after feeding begins. Prolactin levels peak around 20 minutes into nursing sessions lasting several hours thereafter.

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Breastfeeding Techniques and Challenges

Understanding Breast Anatomy and Feeding Dynamics

• The right and left sides of the breast do not communicate, which can complicate breastfeeding. Health teams often use an imaginary clock to identify areas that may be injured or blocked.

• It's essential to empty all sections of the breast during feeding to prevent milk retention, which can inhibit milk production due to negative feedback factors. More milk removal leads to increased production.

• Positioning is crucial for effective breastfeeding; the baby's lower jaw should stabilize while latching onto the breast, allowing for better suction and extraction of milk through a combination of positive and negative pressure.

Managing Early Feeding Sessions

• Newborns may take small amounts initially but will need frequent feedings as they tire quickly or become satisfied. Mothers should adjust positions or express remaining milk for comfort in these early days postpartum.

• The "milk let-down" phenomenon occurs when blood circulation increases in the breast, causing it to feel warm, full, and firm. Mothers should aim to relieve this fullness to avoid discomfort from inflammation.

Proper Latching Techniques

• Pain during latching is not acceptable; mothers should ensure that babies latch fully with their chin pressed into the breast while creating a proper seal with their lips for effective sucking and milk extraction.

• Observing audible sucking sounds by day three indicates effective feeding; visible signs include painless blisters on the baby's mouth and changes in nipple shape after feeding, indicating proper attachment.

Impact of Surgery on Breastfeeding

Surgical Considerations

• Surgical interventions can affect breastfeeding capabilities; aesthetic surgeries often lead women to believe they won't face issues post-operation, but many experience complications due to nerve damage affecting hormonal responses necessary for lactation.

• Aesthetic surgeries frequently involve cutting through glandular tissue rather than just fat, altering the architecture of the breast which can hinder lactation success rates significantly depending on incision types used by surgeons.

Long-term Effects on Lactation

• The type of surgical incision impacts potential breastfeeding challenges; techniques like pedicle flaps can sever important nerves and ducts critical for successful nursing outcomes post-surgery. This results in varying degrees of difficulty across different surgical methods employed by plastic surgeons.

Benefits vs Perils of Breastfeeding Decisions

• While discussing benefits is common, it's vital also to address the drawbacks associated with not breastfeeding; informed decision-making is crucial for mothers regarding their choices about lactation practices based on personal circumstances and health considerations.

• Many women find joy in breastfeeding due to its sensory pleasures and bonding experiences with their infants while providing optimal nutrition tailored specifically from their bodies' resources—highlighting its importance beyond mere sustenance alone.