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Unsolved Mysteries of the Human Mammary Gland: Defining and Redefining the Critical Questions from the Lactation Consultant’s Perspective

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Abstract

Despite advances in knowledge about human lactation, clinicians face many problems when advising mothers who are experiencing breastfeeding difficulties that do not respond to normal management strategies. Primary insufficient milk production is now being acknowledged, but incidence rates have not been well studied. Many women have known histories of infertility, polycystic ovary syndrome, obesity, hypertension, insulin resistance, thyroid dysfunction, hyperandrogenism or other hormonal imbalances, while others have no obvious risk factors. Some present with obviously abnormal breasts that are pubescent, tuberous/tubular or asymmetric in shape, raising the question of insufficient mammary gland tissue. Other women have breasts that appear within normal limits yet do not lactate normally. Endocrine disruptors may underlie some of these cases but their impact on human milk production has not been well explored. Similarly, any problem with prolactin such as a deficiency in serum prolactin or receptor number, receptor resistance, or poor bioavailability or bioactivity could underlie some cases of insufficient lactation, yet these possibilities are rarely investigated. A weak or suppressed milk ejection reflex, often assumed to be psychosomatic, could be related to thyroid dysfunction or caused by downstream post-receptor pathway problems. In the absence of sufficient data regarding these situations, desperate mothers may turn to non-evidence-based remedies, sometimes at considerable cost and unknown risk. Research targeted to these clinical dilemmas is critical in order to develop evidence-based strategies and increase breastfeeding duration and success rates.

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Notes

  1. http://jhl.sagepub.com

  2. http://www.who.int/nutrition/topics/bfhi/en

  3. http://www.bfmed.org

  4. http://www.bfmed.org/Resources/Protocols.aspx

  5. CDC reports that 3,952,841 babies were born in the U.S. in 2012 (http://www.cdc.gov/nchs/births.htm)

  6. Clinical symptoms may include excess body hair (hirsutism), adult acne, and/or male-pattern balding (alopecia)

  7. Hyperandrogenism is the excess of one or more male hormones and includes testosterone, dehydrotestosterone (DHT), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS) and androstenedione.

  8. T. Hale, personal communication. http://www.infantrisk.com/content/presence-macroprolactinemia-mothers-insufficient-milk-syndrome

  9. http://www.mobimotherhood.org/mobi-support-group.html

  10. Quinn, E. A. (2014). Who manages the mammaries? http://biomarkersandmilk.blogspot.com/2013/01/who-manages-mammaries.html

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Acknowledgments

I would like to thank the mothers of the Low Milk Supply and IGT Facebook group and the Mothers Overcoming Breastfeeding Issues (MOBI) listserv for their generosity in sharing their stories and photos for this article. I would also like to express my gratitude to Dr. Russ Hovey for help with the preparation of this manuscript as well as his many insights into individual situations that have helped sharpen my understanding of the physiology of lactation; progress cannot be made without such collaboration across the fields and disciplines.

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The author declare that they have no conflict of interest.

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  1. Expressly Yours Lactation Service, Santa Maria, CA, USA

    Lisa Ann Marasco

  2. Santa Barbara County Public Health Department/ Nutrition Services/Breastfeeding Program, Santa Maria, CA, USA

    Lisa Ann Marasco

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Marasco, L.A. Unsolved Mysteries of the Human Mammary Gland: Defining and Redefining the Critical Questions from the Lactation Consultant’s Perspective. J Mammary Gland Biol Neoplasia 19, 271–288 (2014). https://doi.org/10.1007/s10911-015-9330-7

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