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Anatomy of breast
About 20 radially arranged lobes with duct system draining down to the nipple
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Each lobe can be considered a separate functional unit
Non-lactating breast is about 50% fat, lactating breast is about 30% fat
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About 70% of glandular tissue is within 8cm of the nipple → no need to have big breast
to breastfeed (8cm radius is enough)
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It is lined by mammary epithelial cells (cuboidal or low columnar) → these cuboidal cells
are responsible for secreting milk into the alveolus
Myoepithelial cells surround the alveoli, these are contractile and are responsible for
milk ejection
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Progesterone and oestrogen inhibit milk synthesis
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After birth, fall in progesterone and oestrogen levels → less inhibition of milk production
so glandular tissue in breast starts producing milk
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As milk builds up in the alveolus, it will block further milk production (= autocrine
inhibition) so in order to stimulate milk production you have to keep removing milk from
the breast
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→ if you give bottled milk, your
body will underestimate the amount of milk needed and produce less milk
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→ milk production is led by infant demand : the more milk
you let down, the more milk you produce
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Oxytocin
release not only controlled by suckling, it is influenced by your emotional state, thinking
about your baby can cause a mother to have a let down response
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Lactation is difficult if you’ve given birth prematurally
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​Bromocriptine, Cabergoline
→ few drugs would stop you from breastfeeding, most drugs are not transmitted into
breastmilk
Drugs that augment lactation​ :
They increase prolactin secretion
They are dopamine antagonist
Eg
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Concerns the lactose, calcium, phosphate and milk protein → in glandular cell,
proteins are made in rough ER and packaged into Golgi apparatus
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Fat globules are made in the smooth ER, they then coalesce together and bulge
against the alveoli membrane and are released into the lumen surrounded by
membrane
3
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travel by membrane by osmosis
4
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5
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There can be more fats in breast milk, proteins is lower in breast milk than formula milk
→ this makes formula fed babies become smaller and fatter (as opposed to breast fed
babies which are longer and leaner)
Volume of breast milk is not static → as baby gets bigger, the volume of milk gets
bigger too
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Milk produces when breastfeeding changes with every feed, depending on the time of
day ect…
The amount of fat present in milk goes up as feeding progresses → you have to allow
the baby to empty the breast on one feed so that it can get that fat rich milk at the end
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But hard for babies to metabolise casein
Protein components of human milk is biologically active : contains lactoferrin, lisozymes,
secretory IgA → these all have immune actions as well as nutritional
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Human milk contains LCPUFA (type of fatty acid) which is very important for
brain/retinal development
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In preterm babies, breast
milk is essential to prevent necrotizing enterocolitis (which has a very high mortality) →
you have 7% more chances of having that when you have formula
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Secretory IgA in milk works to protect baby → mother produces secretory IgA against
bacteria she is in contact with, that are in her environment, and passes on these
secretory IgA to the baby through the breast milk
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This translates in less healthcare cost in first year of life
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Less risks of developing allergies/asthma
Reduces the risk of childhood leukaemia, high blood pressure, high cholesterol …
Better cognitive outcome as well
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Women who breastfeed are at lower risk of :
- Breast cancer
- Ovarian cancer

Breastfeeding also uses calories equivalent to swimming 30 laps in a pool → helps to
bring you back to your pre-pregnancy weight
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Signs of a good attachment :
- Mouth wide open
- Mouth full
- Chin is close to breast
- Lower lip everted
- More of the areola is visible above the baby’s mouth than below
Having a good latch is very important because otherwise not enough milk can come out
and baby will not be fed sufficiently

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