ANATOMY AND PHYSIOLOGY OF THE BREAST

ANATOMY AND PHYSIOLOGY OF THE BREAST
I) SURFACE ANATOMY
The breasts are modified apocrine glands, located on the anterior and also partly the lateral
aspects of the thorax. Both genders have breasts but males have rudimentary breasts. Each
breast extends superiorly to the second rib, inferiorly to the sixth costal cartilage (T2-T6),
medially to the sternum, and laterally to the mid-axillary line.The nipple–areola complex is
located between the fourth and fifth ribs.
II) BREAST DEVELOPMENT

In the female, most of the development of the breast occurs after birth. In contrast, in the
male, no further breast development occurs after birth. In the female, growth and branching
of the mammary glands progress slowly during the pre-pubertal years
(Fig. 2.2a). Then, development of the mammary glands dramatically increases at puberty
(Fig. 2.2b),.Only the major breast ducts are formed at birth, and the mammary glands remain
essentially undeveloped until puberty.At puberty, the mammary glands develop rapidly,
primarily due to the proliferation of stromal and connective tissue around the ducts. Growth
of the duct system
occurs through the influence of estrogen and progesterone, secreted by the ovaries during
puberty with further branching of ducts, formation of acini buds, and a dramatic proliferation
of interductal
stroma. This results in the formation of a breast bud. Only at the time of pregnancy does the
breast achieve complete structural maturation and
full functional activity.
During pregnancy, the intralobular ducts develop rapidly, forming buds that become
alveoli, and the stromal/glandular proportions in the breast are reversed. By the end of
pregnancy,
the breast is composed almost entirely of glandular units separated by small amounts of
stromal tissue.
With the onset of menopause, the acini regress further, with loss of both interlobular and
intralobular
connective tissue. With time, the acini structures may be completely absent from the breast in
the postmenopausal female. Thus, the morphologic appearance of the breast in
postmenopausal women is much different from that of women during their premenopausal
years. During the postmenopausal years, both the ductal structures and connective tissue of
the breasts are markedly diminished in size
III) INTERNAL DIVISION
IV) PHYSIOLOGIC BASIS OF BREAST FEEDING ( MILK-LET DOWN
REFELX)
There are two hormones that directly affect breastfeeding: prolactin and oxytocin. A number
of other hormones, such as oestrogen, are involved indirectly in lactation. When a baby
suckles at the breast, sensory impulses pass from the nipple to the brain. In response, the
anterior lobe of the pituitary gland secretes prolactin and the posterior lobe secretes oxytocin.
Prolactin is necessary for the secretion of milk by the cells of the alveoli. The level of
prolactin in the blood increases markedly during pregnancy, and stimulates the growth and
development of the mammary tissue, in preparation for the production of milk. However,
milk is not secreted then, because progesterone and oestrogen, the hormones of pregnancy,
block this action of prolactin. After delivery, levels of progesterone and oestrogen fall
rapidly, prolactin is no longer blocked, and milk secretion begins.
When a baby suckles, the level of prolactin in the blood increases, and stimulates production
of milk by the alveoli. The prolactin level is highest about 30 minutes after the beginning of
the feed, so it’s most important effect is to make milk for the next feed . During the first few
weeks, the more a baby suckles and stimulates the nipple, the more prolactin is produced, and
the more milk is produced. This effect is particularly important at the time when lactation is
becoming established. If the mother stops breastfeeding, milk secretion may stop too – then
the milk will dry up.
Suckling affects the release of other pituitary hormones, including gonadotrophin releasing
hormone (GnRH), follicle stimulating hormone, and luteinising hormone, which results in
suppression of ovulation and menstruation. Therefore, frequent breastfeeding can help to
prevent a new pregnancy.
Oxytocin makes the myoepithelial cells around the alveoli contract. This makes the milk,
which has collected in the alveoli, flow along and fill the ducts . The oxytocin reflex is also
sometimes called the “letdown reflex” or the “milk ejection reflex”. Oxytocin is produced
more quickly than prolactin. It makes the milk that is already in the breast flow for the current
feed, and helps the baby to get the milk easily.
Oxytocin starts working when a mother expects a feed as well as when the baby is suckling.
The reflex becomes conditioned to the mother's sensations and feelings, such as touching,
smelling or seeing her baby, or hearing her baby cry, or thinking lovingly about him or her. If
a mother is in severe pain or emotionally upset, the oxytocin reflex may become inhibited,
and her milk may suddenly stop flowing well. If she receives support, is helped to feel
comfortable and lets the baby continue to breastfeed, the milk will flow again.
It is important to understand the oxytocin reflex, because it explains why the mother and baby
should be kept together and why they should have skin-to-skin contact.
Oxytocin makes a mother's uterus contract after delivery and helps to reduce bleeding. The
contractions can cause severe uterine pain when a baby suckles during the first few days.
The baby's reflexes are important for appropriate breastfeeding. The main reflexes
are rooting, suckling and swallowing. When something touches a baby's lips or cheek, the
baby turns to find the stimulus, and opens his or her mouth, putting his or her tongue down
and forward. This is the rooting reflex and is present from about the 32nd week of pregnancy.
When something touches a baby's palate, he or she starts to suck it. This is the sucking reflex.
When the baby's mouth fills with milk, he or she swallows. This is the swallowing reflex.
Preterm infants can grasp the nipple from about 28 weeks gestational age, and they can
suckle and remove some milk from about 31 weeks. Coordination of suckling, swallowing
and breathing appears between 32 and 35 weeks of pregnancy. Infants can only suckle for a
short time at that age, but they can take supplementary feeds by cup. A majority of infants
can breastfeed fully at a gestational age of 36 weeks.

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ANATOMY AND PHYSIOLOGY OF THE BREAST

II) BREAST DEVELOPMENT

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