Breast Physiology and Benign Diseases 3 Flashcards

1
Q

What happens to breast physiology during the menstrual cycle and at menses?

A
  • —During menstrual cycle
    • estrogen peaks just prior to mid-cycle
      • —causes enlargement of the breast ducts
    • progesterone peaks around day 21 during the luteal phase
      • —causes growth of the breast lobules
    • increased fluid secretion, mitotic activity and DNA production of both non-glandular and glandular tissue occurs and may cause breast tenderness
    • volume of a premenstrual breast increases by 25-30 ml due to increased blood flow and water retention
  • —At menses:
    • —Normalization of hormone levels causes breast size to return to normal and tenderness to resolve
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2
Q

What happens to breast physiology during pregnancy?

A
  • —Prolactin levels increase through the course of pregnancy
    • —10-25ng/ml to 200-400 ng/ml at term
  • —Estrogen, progesterone and prolactin cause new duct formation, ductal branching, and alveolar proliferation
    • —This along with placental lactogen likely cause breast size increase in pregnancy
    • —Breast tenderness is also common and likely due to high levels of progesterone in pregnancy
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3
Q

Describe breast physiology during lactation due to effects of the major hormones that regulate the breast during this time.

A
  • —Prolactin:
    • —Produced by the anterior pituitary
    • —Stimulates milk production within the alveolar cells of the breast
  • —Oxytocin:
    • —Produced by the posterior pituitary
    • —Stimulates myoepithelial cells surrounding the alveoli that lead to milk ejection into milk ducts
    • —“Milk ejection reflex”
  • —Progesterone and Estrogen
    • —Are both at high levels during pregnancy
    • —Inhibit lactation by interfering with prolactin binding of the alveolar cells
    • —Drops with delivery of the baby and placenta lead to lactation due to the longer presence of prolactin in the body
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4
Q

Describe the physiology of lactation pertaining to triggering of secretion and milk production.

A
  • —Milk secretion begins at 3-4 days postpartum
    • due to decrease in circulating steroid hormones
  • —Suckling causes
    • —increase in prolactin levels
      • —initiation and maintenance of milk production
    • increase in oxytocin levels
      • afferent arc: due to stimulation of the paraventricular and supraoptic nucleus of the hypothalamus which produce oxytocin and signal the posterior pituitary gland
      • —efferent arc: occurs with release of oxytocin and stimulation of breast myoepithelial cells to milk let down
  • —Thyroid hormone, Insulin, Insulin-like GF, Cortisol all necessary for optimal breast milk development
  • —Initially, colostrum is produced
    • high levels of WBCs and IgA which coat the baby’s intestines and help prevent pathogens from invading and decrease food allergy
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5
Q

What are the top five benefits of breast feeding?

A
  • Decreased otitis media (50%)
  • Decreased respiratory infections (72%)
  • Decreased GI infections (64%)
  • Decreased NEC (58%)
  • Decreased SIDS (36%)
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6
Q

Describe the proces of lactation cessation.

A
  • Occurs with decreased suckling and decreased milk letdown
  • Lack of suckling also leads to reactivation of dopamine production
    • negatively feeds back and decreases prolactin production
  • Dopamine agonists have been used historically to aid in stopping breastfeeding but are no longer recommended due to significant side effects
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7
Q

What are benefits of breastfeeding for the mother?

A
  • —Decreased postpartum blood loss due to uterine involution
  • —Increased child spacing
  • —Decreased rate of postpartum depression
  • —Decreased premenopausal breast cancer and ovarian cancer
  • —Decreased rate of type 2 DM in women who did not have GDM
  • —Possible increase in return to pre-pregnancy weight
  • —AAP recommends exclusive breastfeeding for 6 months with continuation of breastfeeding for 1 year or longer
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8
Q

What are the contraindications of breast feeding?

A
  • —True CIs
    • infants born with classic galactosemia
    • —in the US, mothers with HIV
  • —Relative CIs
    • untreated active TB, active HSV lesions on the breast, active varicella, and H1N1 should be separated from infants but may be given expressed milk
  • —Misconceptions:
    • —Hepatitis B
    • —Hepatitis C
    • —CMV
    • —Substance abuse and smoking
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9
Q

What are the contraceptive effects of breast feeding?

A
  • —Elevated prolactin levels inhibit pulsatile secretion of GnRH from the hypothalamus
  • Therefore, decreases levels of FSH and LH and inhibits estrogen production and ovulation
  • —Lactational Amenorrhea Method:
    • —breast feeding at regular intervals
      • < 4 hrs during the day
      • < 6 hrs at night
    • exclusive breastfeeding means supplemental feedings can not exceed 5-10 % of total feedings
    • breast pumping may decrease the the neuroendocrine response and may increase likelihood of ovulation/pregnancy
    • after 6 months or with menstruation, this contraceptive method is less effective
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10
Q

What is the effect of contraception post-partum on breast feeding? When should it be started? And what are some good contraceptive choices?

A
  • —Should take into consideration, patient’s plan for breastfeeding
    • exclusively breastfeeding: begin contraception 6weeks- 6 months PP
    • partial breastfeeding/no breastfeeding: initiate contraception between 3 and 6 weeks
  • —Contraceptive choices:
    • —non-hormonal methods will not interfere with breastfeeding
    • —progestin methods: begin at 6 weeks PP
      • —Pills, Mirena IUD, Depo-Provera
    • combination hormonal methods:
      • debated whether effects milk production
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