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EVOLUTION OF NIPPLE
Modified from Weatherly White RCA
Babies can breastfeed from almost all of them.
TYPES OF NIPPLE
TESTING A NIPPLE FOR PROTRACTILITY
Smooth Musculature of Areola and Nipple in Cross Section when Contracted to Make Nipple Erect.
Sites of Supernumerary Nipples Along “Milk Line”.
h Wy r eh ae W m rf defi do M -l t o i
Ramification of Lactiferous Ducts and Mammary Tissue.
nekc H m rf defi do M i o i
Anatomy of the Breast
Which is the correct attachment ?
Signs of Good Attachment
1. 2. 3. 4. 5. 6. More areola visible above baby’s mouth Baby ‘s mouth wide open Lower lip turned outwards Chin close to the breast Mother feels no pain Baby suckles effectively a) a few quick initial “call –up” sucks b) then slow deep sucks, sometimes pausing
CORRECT ATTACHMENT The tongue is under the areola, with the tip of the nipple touching the hard palate.
Nipple Sucking in which the nipple is used as a teat
Process of SUCKLING
Results of Poor Attachment
Pain and damage to nipples Breastmilk not removed effectively Apparent poor milk supply Breasts make less milk
Sore Nipples Fissures Engorgement Baby unsatisfied, wants to feed a lot Baby frustrated, refuses to suckle Baby fails to gain weight
Signs of Good Positioning
1. baby’s body straight - not bent or twisted 1. baby facing the breast, not flat against mother 2. baby close to mother’s body 3. the baby’s whole body supported
INDICATORS OF ADEQUATE BREAST MILK INTAKE
(Early Postpartum Weeks)
1. Breasts full before feeding and softer afterwards 2. Let-Down sensation in mother’s breasts 3. Wet nappies /diapers: 6 or more /24 hours 4. Bowel movements: Several times /day
INDICATORS OF ADEQUATE BREAST MILK INTAKE (Early Postpartum Weeks)
5. Contented baby between feeds. 6. Audible swallowing during a feeding 7. Average weight gain: – 18 – 30 grams /day (3/4 – 1 oz. day) – 125 – 210 grams /week (4 – 7 oz. per week)
Reflexes in the baby
Rooting Reflex When something touches lips, baby opens mouth, puts tongue down and forward Sucking Reflex When something touches palate, baby sucks
Mother learns to position baby Baby learns to take breast
Swallowing Reflex When mouth fills with milk, baby swallows
ry to is H Anatomy of the Breast
1840 Sir Astley Cooper based on anatomical dissection Injection of colored wax into milk ducts inflated ducts Intertwined roots of a tree
Dr. Donna Ramsay et al used sophisticated ultrasound technology (Medela grant)
• Ducts branch closer to the nipple • Conventionally described lactiferous ducts do not exist • glandular tissue found closer to nipple • Subcutaneous fat is minimal close to nipple
Other novel insights
External shape or size of breast is not predictive of its internal anatomy nor its lactation potential Ratio of glandular to fat tissue is 2:1 in lactating breast (1:1 for non-lactating)
[ Breast surgery / enhancement / reduction ]
Other points to note : • 65% of the glandular tissue is located in a 30mm radius from the base of the nipple. • The range of milk duct exiting from the nipple is 4-18 ( do not act as reservoir for milks) • The complex ductal network neither arranged symmetrically nor in radial pattern