Breast Anatomy Beyond the Nipple

2019-07-18T13:29:10+00:00July 18th, 2019|Categories: Fertility Blog|Tags: , , , , |

The internal structures of breasts were first described in 1840 by Sir Astley Cooper. And since then, our knowledge of breasts has changed to include many more than Cooper could have visualized. He described the breast being composed of glandular and adipose (fat) tissue held together by a loose framework of fibers he called Cooper’s ligaments (of course). Cooper’s ligaments support the structure of our breasts and are blamed for stretching during pregnancy and breastfeeding, leading to sagging. If you are interested, there are several exercises that claim to strengthen Cooper’s ligaments. I reviewed them and it appears they work the pectoral muscles (push ups, chest flys and chest press) which lay under your breasts. Working out your pectoral muscles helps your posture but is unlikely to have an impact on the connective tissue inside the breast.


Beyond the ligaments, the inside of a breast is an amazingly complicated structure. Surrounding the nipple like daisy petals are 15 to 20 sections, or lobes. Inside these lobes are smaller sections, called lobules that are arranged in clusters, like grape bunches. At the end of each lobule are tiny “bulbs” that produce milk. The bulbs are called alveoli and that’s where the magic of milk production occurs. From the alveoli,your milk enters the ducts, the thin tubes that carry the milk from the lobules to the nipple. When the milk-ejection reflex occurs, small muscles around the alveoli are squeezing the milk out into the lobules to the ducts and out of the nipples.


Imagine a stalk of broccoli and the tiny flower bits are the alveoli, the stem is the ducts which carry the milk to the nipple. Fat fills the spaces between the lobes and ducts. Actually, most of our breast volume is fat. When you shop for a bra, your cup size is mostly determined by how much fat you have between your connective tissue. That’s why your cup size has no relation to your ability to breastfeed. Smaller breasts (A to C cups) can be easier for babies to latch on, especially in the first days of life.


Working our way out of the breast, the last stop is the nipple. The nipple is in the center of a dark area of skin called the areola. The areola contains small glands that lubricate the nipple during breastfeeding. The bumps on the perimeter of your nipple are glands called Montgomery glands. They constantly secret oil to keep your areola and nipple healthy and moisturized. Montgomery glands also secret your unique scent that attracts your baby to the nipple and helps initiate breastfeeding. We have 12-14 openings in each nipple, and they can spray in any direction as anyone that his squirted milk in unpredictable directions knows.


Five Tips for Exclusively Pumping Moms

2018-11-20T19:50:21+00:00October 17th, 2018|Categories: Fertility Blog|Tags: , , , , |

Breastfeeding isn’t defined by putting your baby to breast. Many moms choose to pump and use a bottle to feed. By choice or necessity exclusive pumping is growing in popularity as pump technology improves and moms are heading back to work with the intention to continue feeding breast milk. There are many reasons for exclusively pumping (EP). Some moms don’t feel comfortable putting their baby to breast or a baby may be born with a condition that makes breastfeeding impossible, like a cleft palate.

While exclusive pumping can be done, it takes some additional preparation to be successful and keep your milk supply strong. Here are some time-tested tips to help you meet your exclusive pumping goals.

1. Be ready for pumping to take over your life for the first week. While you establish your milk supply, pump 12 or more times in each 24 hour period. This works out to pumping every 2 hours day and night, it’s tiring and your breasts may become sore. But, the early days of breastfeeding aren’t easy either, establishing your milk supply and caring for a newborn are challenges for every mom. Once you find your groove and you become a more efficient pumper, you might be able to increase your time between sessions to 4 hours.

2. Have extra pump parts and bottles. Expect the unexpected. You might find yourself without a working pump or clean parts if you have an emergency at home or your car breaks down. Have a spare (or two) of everything, even an extra pump. If your pump motor tires out or a part breaks, you still need to pump and you won’t want to run to the store in the middle of the night.

3. Washing pump parts and bottles will take some time and space in your kitchen. You may feed your baby 12 times per day – will you wash the bottle after each feeding or use a new bottle each time and wash once a day? Either way you will need set aside time each day to clean and organize bottles, nipples and other feeding supplies.

4. Your partner can take on more feedings. No breasts are required for bottle feeding and anytime your baby is hungry, milk is available to for caregivers to feed. Pump before going to bed and let your partner handle the night time feedings. Sleep helps your supply by signaling your body to release milk making hormones.

5. Use hands-on-pumping. Get a hands-free pumping bra or make your own using an old sports bra and use your hands to shorten pumping time. Once your pump is in place and turned on, push with your palms to create gentle pressure starting near your ribs and move toward the nipple. This moves more milk out of your breasts to support a strong milk supply and you finish pumping faster – double bonus!

The one thing EP moms want to share is that it gets easier. The early days of pumping, washing pump parts and bottles non-stop can be overwhelming. But as you and your partner find a system that works for you and your baby, it becomes a natural part of life.

Breast milk is the first probiotic

2016-10-11T01:46:50+00:00October 11th, 2016|Categories: Fertility Blog|Tags: , , , , |

The benefits of probiotics are felt throughout the body– a stronger immune system and better nutrient absorption, among others. Probiotics show up in a range of health foods, yogurt, kefir, kombucha and sauerkraut. None of which are appropriate for young infants (although introducing sauerkraut may result in some interesting photos on your social media feed.)

Providing your baby the health benefits of probiotics is easy if you are breastfeeding. Research shows breast milk is more than just a blend of carbohydrates, fats and proteins. Your breast milk meets the definition of probiotic. The World Health Organization, defines a probiotic as “a live micro-organism which, when administered in adequate amounts, confers a health benefit on the host.” Your breast milk contains hundreds of live micro-organisms in the perfect amount and an easily digestible form for your baby.

The breast milk of healthy moms contains thousands of ingredients, each specific to the needs of a growing human baby. If we focus in on the live micro-organisms only, breast milk hosts a diverse microbial community of more than 200 different groups with unique DNA and characteristics. About half of the micro-organisms are generic and shared in all human milk, the other half is unique to each mother and specific to her environment. When seen through a microscope, your milk is as distinctive as your fingerprints and provides your baby the cells needed to thrive in the environment you share.

One mystery of breast milk doctors are working on is how the micro-organisms that are exclusively yours get into your milk, since these cells are found exclusively in your digestive system. Scientists now think the bacteria that lives in your intestines migrate via your bloodstream to your mammary glands during the final weeks of pregnancy. When this bacteria arrives at your breast cells, it becomes one of the components of breast milk passed on to your baby. In this way, your body creates a customized blend of probiotics made just for your baby.

This article was written using these sources.

Ballard, O., Morrow, A. (2013). Human Milk Composition: Nutrients and Bioactive Factors. Pediatric Clin North Am. 2013 Feb; 60(1): 49–74.doi: 10.1016/j.pcl.2012.10.002

Bode, L., McGuire, M., Rodriguez, J., Geddes, D., Hassiotou, F., Hartmann, E., McGuire, M. (2014).It’s Alive: Microbes and Cells in Human Milk and Their Potential Benefits to Mother and Infant. Advances in Nutrition.

Refusing the bottle? Milk tasting soapy or sour? Excess lipase may be the cause.

2015-11-13T20:49:27+00:00November 13th, 2015|Categories: Fertility Blog|Tags: , , , , , , , |

Lipase is a naturally occurring component in breast milk and in every person’s digestive system, it helps our bodies break down the fat we eat and use it in useful ways inside our bodies. Lipase plays an important role in keeping your baby healthy by helping her body absorb the nutrients from your breast milk.

If breast milk has too much lipase, it begins to digest the fat in the milk and leaves behind a soapy, metallic or sour taste. Unfortunately, many mothers discover their milk has excess lipase after pumping and storing for a few weeks. Once lipase has changed the taste of the milk, it cannot be returned to the original state.

Fortunately, the stored breastmilk is safe for your baby to drink, although many babies will refuse the bottle due to the change in flavor and smell.

To determine if your breastmilk has excess lipase:

Pump or hand express 2-3 ounces of breastmilk, place it in the refrigerator. Every hour, smell and taste a small amount of the milk. Write down the time you notice a change in the smell and taste. Do this a few times until you find a consistent time and be sure there are no odors in your refrigerator your breastmilk could be absorbing. Some moms find their milk changes right away (1-2 hours), others find the milk takes longer to show changes, (18-20 hours).

If your milk has excessive lipase, you can still freeze, store and thaw your milk for your baby. You will need to take some additional steps before freezing your milk:

• To neutralize the lipase, you will need to heat your milk to 180 degrees.
• Most moms pour their milk into a metal bottle, then use a bottle warmer without an automatic safety shut off (otherwise the bottle warmer will not allow your milk to get to the high temperature required).
• A bottle warmer that submerges the entire bottle, rather than just part of the bottle will raise the temperature of your milk faster.
• Stir your milk gently with the thermometer.
• Using a metal bottle will allow you to place the bottle into an ice bath immediately after reaching 180 degrees. Use caution when quickly cooling a glass bottle, it may shatter.
• Many moms heat their pumped milk upon returning home at the end of the workday. You might ask your partner to heat and cool your milk while you breastfeed.

If you need to heat your milk at work but can’t use the bottle warmer, consider the microwave. Typically, microwaving breastmilk is not recommended. The high, uneven heat of the microwave can inactivate some components in your breastmilk. However, if your baby is doing some drinking from the breast and the microwave is the only option for preserving your milk, it may be a good choice.

After cooling you breastmilk, use Milk Trays or storage bags to freeze your milk as usual.

Excessive lipase in your milk can present a unique challenge for storing your breastmilk and bottle feeding. Your baby may continue to refuse the bottle for a few weeks even after the lipase has been corrected. Continue to offer the bottle and, eventually, your baby will likely give the bottle another try.

Talk to your pediatrician or lactation consultant about any concerns you have about breastfeeding and/or your baby’s health.


2012-09-13T10:46:40+00:00September 13th, 2012|Categories: Fertility Blog|Tags: , |

(This is a great newsletter from Healthy Babies Happy Moms, Inc a wonderful clinic in Rhode Island that helps moms navigate the early days of motherhood and breastfeeding. I thought this information was important and want to share it with Milkies readers.)

Sometimes, a lot of what we do at HBHM Inc. involves helping moms navigate the system to get what they need for their particular situation. Read below for the experience of one of our clients, a Rhode Island mother of two small children, who is also a RN with a Master’s of Public Health. In this instance, she taught us new information on DHA/ARA content in formula and an insurance benefit we were not even aware of, which might be helpful for mothers who need formula because of a low milk supply.

DHA/ARA Concerns and Insurance Coverage of Formula

Controversy surrounds the use of DHA and ARA additives to infant formula. While DHA and ARA are compounds are also found in breast milk, manufactured sources of DHA and ARA are structurally different and may not actually be beneficial. More concerning are the potential negative health effects of these additives, which remain largely untested in infants. DHA and ARA additives can expose babies to environmental contaminants and fungal toxins. These contaminants and toxins are most concerning for infants with immature immune systems and can cause unpleasant side effects in all babies. For a full discussion of the dangers and side-effects of DHA and ARA in infant formula, visit this link.

The side effects of DHA and ARA are what I noticed first in our newborn. I had to give him formula due to a low supply issue I have had with both of my children, despite my best efforts to exclusively breastfeed my babies. He had watery explosive diarrhea, excessive foul smelling gas and what I suspected was abdominal cramping by observing how fussy he became when he passed gas or had diarrhea. Our pediatrician said “babies have gas” but I felt like this was more than just a common case of fussiness. I learned about the possibility that DHA and ARA were to blame from the website Figuring that this was an easy change to make, I set out to buy formula that did not contain DHA or ARA. Sounds simple, but it wasn’t.

After hours spent pouring over formula websites and on phone calls with formula companies, I learned that most formula makers have stopped producing formula without DHA or ARA. The only company that makes a formula without these additives is Baby’s Only, however, this formula is a “toddler” formula and I did not feel comfortable giving this formula to my newborn.

Through my research I discovered that Good Start does make a DHA/ARA free formula but it is only sold in Canada. I called the Canadian Good Start company (Nestle) to ask if I they could send some formula to me but they couldn’t do it. Customs rules do not allow things that are regulated by the FDA to be sent across borders. The man I spoke to on the phone was perplexed. Why was I calling him about this formula when it is actually made in the United States and then shipped to Canada? I wanted the answer to this question too so I called the American Good Start company. I know that you manufacture this formula here, I said, could you just send me a can? But no, they couldn’t. “Not FDA approved for sale in the US,” was the response I received.

I happened to have a friend who was visiting Canada at the time and she brought three precious cans of DHA/ARA free formula back for me, hidden in the trunk of her car. My baby is now three months old and we’ve been using the formula for the past two and a half months. He’s doing so well on it, virtually no gas, normal poops. He’s an incredibly happy and easy baby. But we’re running out of formula and I don’t have anyone to get it for me now. Short of driving six hours to Canada to get it myself, I’m out of luck.

My solution is the one that you may also have to consider, if you are concerned about DHA and ARA in infant formula. Through my research I learned that while all formulas contain these additives, they contain them in different quantities. Earth’s Best, Enfamil and Good Start contain 17mg of DHA and 34mg of ARA per serving but Similac contains less, 8mg DHA and 22mg ARA (personal communication with formula company representatives via phone). If you choose to use Similac, at least you will be exposing your baby to the least amount of DHA and ARA possible.

One unexpected surprise from my previous experience was to find out that Moms with low milk supply can get supplemental formula for their babies for free through insurance. To take advantage of this benefit, ask for a prescription for the formula from your baby’s pediatrician. Some insurance plans may also require that the pediatrician submit a letter of medical necessity in which she should state that this is a breastfed baby with “failure to thrive” due to low breast milk supply. Other insurance plans do not require a letter for babies under 1 year old and only a prescription is required. It’s best to call your insurance provider to ask what sort of documentation is needed.

In my personal experience, I have dealt with two insurance carriers (Blue Cross Blue Shield of New England and Tufts Health Plan) and I have had formula covered without any issue. As a mom with a low milk supply, having formula covered by insurance is such a gift. Paying for formula after heroic attempts to establish adequate milk supply would be like adding insult to injury. It is good to know that insurance companies support the efforts of breastfeeding mothers with low milk supply by helping them to make up the difference in the amount of milk their baby needs. Hopefully, they will be equally supportive someday of coverage for lactation consults and breast pumps!

Check out this great website here-


2012-04-03T10:47:50+00:00April 3rd, 2012|Categories: Fertility Blog|Tags: , |

This week I posted a link to an article that suggested mothers are feeling too much pressure to breastfeed. The author referenced a study in which mothers seemed “stressed” and felt their doctor focused on six months of breastfeeding at the exclusion of the overall health of the family.

We know there are a few moms that are physically unable to breastfeed. That must be a truly frustrating ordeal and I have nothing but respect for mothers in that situation. However, the majority of mothers and babies are physically able to breastfeed. So why are only 14.8% of babies are exclusively breastfed for six months? A few social factors that are associated with shorter duration include smoking during pregnancy (10%), Caesarean birth (32% of births), a baby going to NICU and mom returning to work before 6 months of infant’s age (55%).

The majority of research shows that many moms are also undermined in their goals for a strong milk supply and suitable latching baby by early supplementation, pacifiers and inappropriate birth interventions. The guilt that so many mothers feel about their unsuccessful breastfeeding attempts can make the recommendations of exclusive breastfeeding for six months feel unfair. I understand the frustration, but it should not be directed at the recommendations for exclusive breastfeeding, but the raod blocks that created the difficulties to a fulfilling breastfeeding experience.

Several articles have discussed this study and the suggestion to soften up the 6 month recommendation. The rationale is that if we just took the pressure off mothers they would be happier and more confident in their mothering ability. This theory is based on lowering the bar to make everyone feel like they accomplished something reminds me of giving every kid a trophy so no one feels bad. Except the kid/trophy scenario is a somewhat arbitrary contest, unlike breastfeeding.

With a new baby, life changes forever and completely. One physician observed many families attempt to regain control during the chaotic early months by changing the feeding method in hopes baby sleeps longer and relieves stress on the family. What new parent hasn’t wished for a magic, baby-whisperer trick to get their baby to sleep faster and for hours at a time?

So the choice is framed, family harmony or exclusive breastfeeding. Hmmm- I wonder which will prevail?

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