Thursday, March 3, 2011

Breast Anatomy and Physiology

Breast anatomy should be very familiar to anyone sitting for the Exam.  Not only is it crucial to understanding lactation, but it is also good testing ground for the IBLCE board since anatomy is the same internationally.  Although breastfeeding requires breasts and they have been used throughout the ages, breast anatomy is remarkably understudied (well, by the scientific audience, I should say).  I am amazed at the history of how we originally learned, evaluated and understood the mammary gland.  In case some of you haven't heard the lecture on the breast anatomy's history, I'll give a quick synopsis.  Medical professionals, biology students, lactation experts--all based all their information, decisions and future studies based on breast anatomy research that occurred over 160 years ago.  

Sir Astley Paston Cooper, M.D., FRCS, Bart., (1768-1841) published his findings in On the Anatomy of the Breast in 1840, just before his death.  This publication demonstrated Cooper's mastery of breast anatomy through outstanding illustrations. His findings were never collaborated or even verified by additional trials.  His pictures were widely circulated.  Unfortunately, these early illustrations showed some findings that were later proven false.  The discrepancies were created by the procedure Cooper used to trace the ducts that terminated at the nipple.  He laid out the breast from a cadaver in a asymmetrical way to best suit his study (one reason it is not accurate). Next, he injected dye into each nipple opening to better understand the labyrinth of ducts in the breast.  The initial injection caused a bubble to form when the pressure first entered the breast.  The best way for me to describe this is when a long balloon for making animals is blown up, the first big breath creates a bubble at the front of the balloon before filling the rest of it with air.  A similar phenomenon occurred with the dye in the breast. A bolus of dye created a "bubble" which were named "lactiferous sinuses."  

Finally, in 2006, Peter Hartman began anatomy studies that used ultrasound to trace milk ducts.  From this recent study the earlier depictions of breast anatomy were proven inaccurate.  
The point needs to be made that anyone who has had their anatomy training between 1840 and 2006 needs a refresher course.  A link to a journal of the breast's history and current research is . This journal article can be printed and shared.  Medela also has free illustrations of the old and new anatomy on their website  

There still needs to be much more research on lactation, physiology of lactation and anatomy of the breast.  I am constantly amazed that so little has been done to study the number one way to sustain the life of a child...hope someone gets motivated to tackle this huge project.  In the meantime, take this quick study module as a refresher on anatomy  The site has some other beneficial modules as well.  Hope this quick blog gets the mind thinking.  I know this is just a jumping off point.  I would also recommend reviewing the hormones that aid in lactation and do a "Google search" on "the lactating breast."  Just check the date on your research...prior to 2006, the research may have been based on faulty findings.

Lactation information, theories and protocols are changing all the time...keep "abreast" of what's new in the field!

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