Research Alert – Anatomical Breast Variability

Anatomical breast variability has been a subject of focus in The Breastfeeding Atlas since the first edition was published in 1999. Kay Hoover and I have observed clinically that flat, inverted, or large nipples and large breasts create significant challenges to breastfeeding. We have extensively photographed and described these four anatomical breast variations, and have long advocated for clinical research to examine the effects of anatomic variability on breastfeeding outcomes.

The paper by Vazirineja, et al (see abstract below) validates our observations that some breast and nipple variations negatively affect early infant weight gain. Previous research has documented that flat nipples and inverted nipples impact on breastfeeding. The new research identifies a negative effect of large nipples and large breasts upon infant weight. The difference in the average weights at 7 days was significant; 215 g (about half a pound) between the “normal” and the variations group.

It would have been helpful for the researchers to specifically describe breast and nipple sizes and to quantify what they meant by “large nipple” and “large breast.” Providing normative ranges and accurate size measurements will help clinicians identify women and infants in risk categories.

We hope these important research findings prompt earlier interventions to prevent infant weight loss. We advocate for individual assessment and active management of lactation when breast or nipple variations are observed. Appropriate interventions might include close weight monitoring, use of nipple shields, “insurance” pumping, and alternative feeding of the infant with pumped milk to prevent infant weight loss.  Creative positioning strategies, effective parental counseling, and tincture of time also support optimal breastfeeding outcomes and help prevent untimely weaning.

The article abstract appears below.  A full text of the article is available at:

http://www.internationalbreastfeedingjournal.com/content/4/1/13

The effect of maternal breast variations on neonatal weight gain in the first seven days of life

Reza Vazirinejad, Shokoofeh Darakhshan, Abbas Esmaeili

International Breastfeeding Journal 2009, 4:13doi:10.1186/1746-4358-4-13

Abstract

Background

This study aims to examine whether specific maternal breast variations (such as flat nipple, inverted nipple, large breast or/and large nipple) are barriers for weight gain in breastfed infants during the first seven days of life.

Methods

In this prospective cohort study, 100 healthy term neonates were followed from birth to day seven in two groups; Group A: fifty neonates born to mothers with specified breast variations and Group B: fifty neonates born to mothers without such breast variations (“normal breasts”). All neonates were the first child of their families and there was no sex ratio difference between the two groups. Neonates’ weight at birth and day seven were measured and the mean weight differences in the two groups were compared using paired t-test.

Results

Neonates born to mothers without the specified breast variations had a mean weight gain of (+) 53 ± 154.4 g at day seven., Not only there was no increase in the mean weight of neonates in the other group, but they had a mean decrease of weight of (-) 162 ± 125.5 g by the seventh day of their life compared to birth weight. Thus, neonates born to mothers without breast variations had significantly greater weight gain than neonates born to the mothers with the specified variations (p < 0.01).

Conclusion

Breast variation among first-time mothers acts as an important barrier to weight gain among breastfed neonates in the early days of life. Health professionals need skills in the management of breastfeeding among mothers with the specified breast variations, so that mothers are given appropriate advice on how to breastfeed and overcome these problems.

For students and clinicians interested in reviewing the literature on the subject of breast and nipple anatomy, we suggest the following

Additional References

Caglar MK, Ozer I, Altugan FS. Risk factors for excess weight loss and hypernatremia in exclusively breastfed infants. Brazilian Journal of Medical and Biological Research 2006; 39:539-544.

Cooper W, Atherton H, Kahana M, Kotagal U. Increased incidence of severe breastfeeding malnutrition and hypernatremia in a metropolitan area. Pediatrics 1995; 96(5):957-960.

Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 2003; 112(3):607-619.

Livingstone VH, Willis CE, Abdel-Wareth LO, Thiessen P, Lockitch G. Neonatal hypernatremic dehydration associated with breastfeeding malnutrition: a retrospective survey. Canadian Medical Assoc J 2000; 162(5):647-652.

Ramsay D, Kent J, Hartmann R, et al. Anatomy of the lactating human breast defined with ultrasound imagine. J Anatomy 2005; 206(6):525-534.

Wilson-Clay B, Maloney BM. A reporting tool to facilitate community-based follow-up for at-risk breastfeeding dyads at hospital discharge. Current Issues in Clinical Lactation, 59-67, 2002.

Yaseen H, Salem M, Darwich M. Clinical presentation of hypernatremic dehydration in exclusively breastfed neonates. Indian J Pediatr 2004; 71(12):1059-1062.

The Mothers Milk Bank of Austin Turns 10!

Ten years ago, two visionary neonatologists, George Sharpe MD and Audelio Rivera, MD dreamed of creating a donor human milk bank in Central Texas to serve fragile preterm babies in the NICU setting.  Together with a handful of nurses, lactation consultants and parents, they crafted a non-profit, community-based organization that is now a leader in the field of human milk banking.  At the time of the founding of the Mothers Milk Bank at Austin (MMBA), the US had only 4 milk banks.  Since that time, the MMBA has helped mentor the start-up of 5 new milk banks in other cities, and pioneered the science of nutritional labeling for human donor milk.  Barbara Wilson-Clay, a co-founder and Vice President of the Board of Directors, is pictured in the center.  Happy Birthday MMBA, and GO Milk Power!

Poster Presentation Winners at the 2009 ILCA Conference in Orlando Win The Wilson-Clay and Hoover Conference Research Presentation Award

Two honors were awarded for the best posters presented at the 2009 ILCA Conference. The award for the Research Poster went to Azza Hussein Ahmed, DNS, RN, IBCLC, CPNP, for “Effect of Breastfeeding Educational Program Based on Bandura Social Cognitive Theory on Breastfeeding Outcomes Among Mothers of Preterm Infants to Support Breastfeeding Mothers.” The award for the Project Poster went to Ellen Lechtenberg, BS, RD, IBCLC, for “Fat Free Human Milk for Chylothorax: From Idea to Development, to Standard of Care.” Abstracts for both posters will appear on the ILCA Website www.ilca.org

The Conference Research Presentation Award, sponsored by Barbara Wilson-Clay and Kay Hoover, will be split between the two poster award recipients.

Congratulations for this outstanding work!

Baking Up Our Breastfeeding Photos

We know our breastfeeding photos are used for many different purposes. We really enjoyed seeing them used on cake for the WABA World Breast Feeding Week. Click the image to see it bigger. You can read the full story here:
http://www.lakenheath.af.mil/news/story.asp?id=123162196

LactNews Website Redesign

We’ve been working hard to restructure our website so it is easier to use for everyone. You will still find all our products for sale under the products section. We’ve also setup a new online shopping site to take all our product orders. You can see our new site at www.BreastFeedingMaterials.com

We plant to bring you more lactation training and information in 2009. Check back with www.LactNews.com for updates or sign up on our email newsletter mailing list.