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Anatomy and Physiology of the Breast during Pregnancy and Lactation
Abstract
The mature breast is located within the anterior thoracic wall, lying atop the pectoralis major muscle. Pubertal changes lead to incomplete development of the breast, a process which is only completed during pregnancy. The incomplete breast consists mostly of adipose tissue but also lactiferous units called lobes. These eventually drain into the lactiferous ducts and then into the lactiferous sinus and then to the nipple-areolar complex. During pregnancy, the breast undergoes both anatomic and physiologic changes to prepare for lactation. During the first trimester, the ductal system expands and branches out into the adipose tissue in response to the increase of estrogen. Elevated levels of estrogen also cause a decrease in adipose tissue and ductal proliferation and elongation. Estrogen also stimulates the pituitary gland which leads to elevated levels of prolactin. By the twentieth week of gestation, mammary glands are sufficiently developed to produce components of milk due to prolactin stimulation. Milk production is inhibited by high estrogen and progesterone levels and colostrum is produced during this time. In the third trimester and then rapidly after birth, these levels decrease, allowing for milk production and eventual let-down to allow for breastfeeding. Most pregnancies cause the areola to darken, the breast to increase in size, and the Montgomery glands to become more prominent. Post-lactational involution occurs at the cessation of milk production caused by a decline in prolactin.
... Its architectural dynamics fluctuate throughout the menstrual cycle, and crucial transformations occur during puberty, gestation, lactation, and menopause. Complete mammary maturation is exclusively achieved during pregnancy [18,19]. ...
... This form of the mammary gland is the most mature and developed [27]. Changes emerging during pregnancy regress shortly after lactation ends and the breast structure returns to its pre-pregnancy state [19]. ...
... All of these factors lead to rearrangement and proliferation of mammary cells, leading to formation of terminal end-joining compounds (TEBs) at the end of the mammary ducts. In pregnancy, branching takes place, directed specifically by the hormone's progesterone and prolactin [19]. ...
This review shows how mammary stem cells (MaSCs) influence breast development, breastfeeding, and breast cancer risk. MaSCs, which can differentiate into various cell types, are vital for breast tissue health, but also disease development in breast tissue. Research shows that breastfeeding affects MaSCs, offering protection against breast cancer through various mechanisms. Hormonal changes such as increased prolactin concentration, oxytocin secretion, lower progesterone levels, and reduced exposure to estrogen during lactation promote apoptosis in potential cancer cells, boost immune surveillance, and modulate inflammation. Key findings reveal that pregnancy at an earlier age and extended breastfeeding reduce MaSC numbers, lowering cancer risk. Additionally, breastfeeding induces various epigenetic changes, such as DNA methylation and histone modification, which provide long-term protection against the development of cancer. Components of breast milk, like alpha-lactalbumin and lactoferrin, contribute by promoting cancer cell apoptosis and inhibiting tumor growth. The dual benefits of breastfeeding are reduced breast cancer risk for mothers and immunological advantages for infants. Multicenter epidemiology research has focused particular attention on longer breastfeeding duration associated with a reduced risk of triple-negative breast cancer. This review offers comprehensive evidence that breastfeeding protects against breast cancer through various biological, hormonal, and molecular mechanisms, showing the importance of promoting breastfeeding as a natural cancer prevention method. This article reviews the role of mammary stem cells in breast development, lactation, and breast cancer.
... During pregnancy, progesterone and estrogen trigger proliferation and elongation of ductal tissue, increased lobular branching, and differentiation of mammary alveoli. 42,43 Estrogen also increases the size of the anterior pituitary gland by increasing the number and size of lactotrophs, which ultimately leads to production of more prolactin. 43 Prolactin is the main hormone responsible for lactation by stimulating MEC to make milk components. ...
... 42,43 Estrogen also increases the size of the anterior pituitary gland by increasing the number and size of lactotrophs, which ultimately leads to production of more prolactin. 43 Prolactin is the main hormone responsible for lactation by stimulating MEC to make milk components. Milk can be produced by approximately 20 weeks gestation, but full production is inhibited by sex hormones. ...
... Progesterone, in particular, down-regulates prolactin receptors on mammary alveolar cells and milk component synthesis and prevents mammary epithelial cells from forming tight junctions. 42,43 After childbirth, concentrations of those hormones decrease, especially progesterone with the delivery of the placenta, and prolactin and oxytocin increase. 43 As such, lactogenesis during pregnancy and to approximately 2 days after birth is largely driven by paracrine hormonal regulation, while on-going milk production is driven by autocrine regulation ultimately dictated by milk removal. ...
Breastfeeding is the most complete nutritional method of feeding infants, but several impediments affect the decision to breastfeed, including questions of drug safety for medications needed during lactation. Despite recent FDA guidance, few labels provide clear dosing advice during lactation. Physiologically based pharmacokinetic modeling (PBPK) is well suited to mechanistically explore pharmacokinetics and dosing paradigms to fill gaps in the absence of extensive clinical studies and complement existing real‐world data. For lactation‐focused PBPK (Lact‐PBPK) models, information on system parameters (e.g., expression of drug transporters in mammary epithelial cells) is sparse. The breast cancer resistance protein (BCRP) is expressed on the apical side of mammary epithelial cells where it actively transports drugs/substrates into milk (reported milk: plasma ratios range from 2 to 20). A critical review of BCRP and its role in lactation was conducted. Longitudinal changes in BCRP mRNA expression have been identified in women with a maximum reached around 5 months postpartum. Limited data are available on the ontogeny of BCRP in infant intestine; however, data indicate lower BCRP abundance in infants compared to adults. Current status of incorporation of drug transporter information in Lact‐PBPK models to predict active secretion of drugs into breast milk and consequential exposure of breast‐fed infants is discussed. In addition, this review highlights novel clinical tools for evaluation of BCRP activity, namely a potential non‐invasive BCRP biomarker (riboflavin) and liquid biopsy that could be used to quantitatively elucidate the role of this transporter without the need for administration of drugs and to inform Lact‐PBPK models.
... According to reports from the World Health Organization (WHO), breast cancer alone accounted for 2.3 million cases worldwide, causing 670,000 deaths in 2022 [1]. The mammary glands are bilaterally distributed and superficially positioned in the pectoralis major muscle [2]. They consist of lobules and a network of milk-producing epithelial structures. ...
... Lobules further aggregate to form lobes interspersed with adipose tissue. Cooper's ligaments, which comprise fibrous connective tissue, provide structural support by anchoring the breasts to the underlying musculofascial layer [2]. In most cases, breast cancer occurs within the ductal epithelium and results in ductal carcinoma. ...
... Each lobule drains into a lactiferous duct and lactiferous sinus, which then release milk onto the nipple's surface. 11,12 During a woman's life, the breast undergoes physiological changes during menstruation, pregnancy, childbirth and menopause. 3 During pregnancy, the ductal system expands, and there is proliferation and elongation of lactiferous ducts. ...
... The lactiferous sinuses serve as reservoirs for milk during lactation. 12 Bacterial mastitis is most often associated with lactation. 11 Infection in the breast can occur through lymphatic or blood route, direct introduction of pathogens (via cracked nipples), or through spread from nearby structures. ...
: A breast abscess often arises as a complication of bacterial mastitis, particularly when treatment is either insufficient or delayed. These abscesses are usually caused by pyogenic bacteria. The primary treatment involves draining the abscess, and antibiotics are prescribed based on the results of a culture report.
: The present study was conducted to address microbiological profile of breast abscess and elucidates antimicrobial susceptibility of isolates.
This retrospective study was conducted at tertiary care hospital, Jamnagar from July 2023 to June 2024. Total 100 suspected breast abscess cases were assessed. Pus aspirates from abscesses received at microbiology laboratory were cultured and examined for bacterial growth by various microbiological methods. After the identification of the bacterial pathogen, antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion method on Muller Hinton agar according to CLSI guidelines.
Majority of cases belonged to lactational group. The most common bacterial isolate was (83.5%), and out of them 41% were methicillin-resistant (MRSA). Others included Enterococcus species and gram-negative organisms like , , , and . isolates (both MSSA and MRSA) showed good sensitivity towards drugs like tetracycline , cotrimoxazole and linezolid.
The maximum occurrence (71% cases)of breast abscess was seen in lactating women. was the predominant organism found. For our institute recommended drugs for an initial empirical therapy are amoxycillin-clavulanic acid, erythromycin and clindamycin. Pregnant and lactating mothers should be trained and counselled on breastfeeding and breast hygiene. Following strict infection control practices in maternity wards can help reduce the risk of acquiring infections during the hospital stay.
... The breast tissue undergoes physiologically mediated anatomical changes during pregnancy and lactation that is caused by Estrogen and Progesterone, which are important to prepare the breast for lactation during pregnancy [1]. Estrogen stimulates the growth of breast duct cells and the secretion of prolactin. ...
... These postures may increase pressure on the intervertebral discs, causing strain on the back muscles, which could further lead to fatigue and discomfort [9], and consequent deformities of the thoracic spine may further ensue. Breast size increments in two or three folds are also evident during lactation [1], resulting in tendencies for women to wear bigger fitting brassieres during their breastfeeding periods [10]. Spinal inclination most likely increases in the presence of a heavy load on the anterior thoracic wall [11]. ...
Background
Thoracic spine postural dysfunctions are common postpartum-related health problems, compromising breastfeeding efficacy and quality of life among women. Previous studies have particularly associated these conditions with increased breast sizes in several populations. However, such empirical evidence is scarce in the Nigerian population.
Objectives
To investigate the relationship among breast size, thoracic-kyphosis, and -spine pain among postpartum Nigerian women.
Methods
This correlational survey involved 400 consenting postpartum mothers (between 0 and 24 months of postpartum period). Their breast size, thoracic spine posture, and pain were measured using a measuring tape (cm), inclinometer, and Revised Oswestry thoracic spine pain disability questionnaire, respectively. Data were analyzed using descriptive and relevant inferential statistics at p < 0.05.
Results
The majority of the participants fall under the category of breast cup size B (61.75%), have no history of thoracic spine pain (87.4%), and about half of them (50.2%) have normal thoracic spine posture (low category with values ranging between 20⁰ and 35⁰. Breast size was significantly (r = 0.162, p = 0.001) correlated with thoracic spine posture but showed no significant correlation (r = 0.066, p = 0.622) with thoracic spine pain.
Conclusion
Increasing breast size is weakly associated with a tendency towards a kyphotic posture of the thoracic spine. Postural education and care around adequate support of the breast with suitable fitting brassieres may help prevent kyphotic deformities. Future research with a randomized control trial and long-term follow-up is recommended to further confirm the causal relationship of these variables.
... This intricate system is coordinated by an interplay of hormones that ensure the successful production and ejection of milk, providing nourishment for the infant. The mammary gland, primarily influenced by estrogen, prolactin, and cortisol, undergoes significant changes to prepare for lactation (Alex et al., 2020). During pregnancy, estrogen stimulates the proliferation of ductal structures within the mammary glands, while progesterone promotes the formation of alveolar structures necessary for milk production (Alex et al., 2020). ...
... The mammary gland, primarily influenced by estrogen, prolactin, and cortisol, undergoes significant changes to prepare for lactation (Alex et al., 2020). During pregnancy, estrogen stimulates the proliferation of ductal structures within the mammary glands, while progesterone promotes the formation of alveolar structures necessary for milk production (Alex et al., 2020). Cortisol also plays a role in mammary gland development by enhancing the effects of prolactin and other lactogenic hormones (Kabotyanski et al., 2006). ...
The article "Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications" explores how climate change affects lactating individuals and their infants. It reviews the physiological, socioeconomic, and public health challenges posed by rising temperatures and heat stress, which can reduce milk production and alter its composition. The article also addresses issues such as malnutrition, water scarcity, and exposure to environmental toxins, highlighting the need for targeted mitigation strategies to support lactating individuals in a warming world. It emphasizes a holistic approach, incorporating a social-ecological perspective, to develop effective public health interventions.
... The areola is located in its center (Gaskin, 2017). Breast does not develop fully during the adolescent stage and they are due to puberty-related changes, but during pregnancy, they are fully developed (Alex et al., 2020). The breast undergoes anatomical and physiological changes during pregnancy in order to get ready for breastfeeding. ...
... The areola darkens, the breast enlarges, and the Montgomery glands become more noticeable during most pregnancies. When a decrease in prolactin results in the end of milk production, post-lactational involution takes place (Alex et al., 2020). Lactation is the process by which the mammary glands of a postpartum female breast produce and secrete milk in response to a baby suckling at the nipple. ...
Introduction: Breast milk and hand hygiene are very important aspect for breastfeeding mothers. This is because of the role breast milk plays in the early stage of development of the infant. Though breast milk is very essential for infants, its quality can be compromised when proper hygiene practices are not observed by the breastfeeding mothers. Therefore, this study is aimed at determining the knowledge and practices of breast milk and hand hygiene among breastfeeding mothers in tertiary health institutions in Abakaliki, Ebonyi State, Nigeria. Method: The study adopted a cross-sectional descriptive design with a purposive sampling method to select 215 breastfeeding mothers who visited two tertiary health institutions for immunization. Data among were analyzed. Ethical approval and permission were obtained from the participating hospitals and University of Port Harcourt Ethics Committee, the institution the author affiliates. Result: The result revealed that 71.3% and 75.3% had good knowledge of breast milk and hand hygiene while 2.3% and 1.4% had poor knowledge. The study noted that 58.1% and 60.9% of the breastfeeding mothers practices breast milk and hand hygiene respectively while 21.4% and 9.8% had poor practice. The knowledge of breast milk and hand hygiene was significantly associated with practices of breast milk and hand hygiene. The result further revealed that only knowledge of breast milk hygiene was significantly associated with parity while knowledge of hand hygiene, practices of breast milk and hand hygiene was not significantly associated with parity. Conclusion: Though there is high knowledge of breast milk and hand hygiene among the breastfeeding mothers but the knowledge did not reflect with the practice. There is therefore a need for continuous education of the breastfeeding mothers on the practice of milk and hand hygiene and its importance to the growing infants.
... The breast is a well-vascularized anatomical structure formed by both glandular and fatty tissue. The glandular tissue is under the influence of different hormones, such as oestrogen [1], progesterone [1,2], or prolactin [3,4], so over the years, because of hormonal changes, the mammary gland undergoes volume modifications that condition the overall breast volume and shape. The fatty tissue that conforms to the breast can also increase or decrease according to changes in body weight or other factors. ...
... The breast is a well-vascularized anatomical structure formed by both glandular and fatty tissue. The glandular tissue is under the influence of different hormones, such as oestrogen [1], progesterone [1,2], or prolactin [3,4], so over the years, because of hormonal changes, the mammary gland undergoes volume modifications that condition the overall breast volume and shape. The fatty tissue that conforms to the breast can also increase or decrease according to changes in body weight or other factors. ...
(1) Background: Breast reduction is one of the most frequently performed plastic surgeries in women worldwide. The Wise pattern breast reduction is one of the most frequent skin designs for this surgery. One key point of the surgery is to preserve a well-vascularized NAC by using different surgical pedicles. This study aims to test and update the anatomical knowledge of breast vascularization, the topographic and anatomical basis of the different surgical vascular pedicles, and the differences between the right and left sides. (2) Methods: A descriptive observational anatomical study was carried out on 15 breasts from 10 cryopreserved body donors. A dissection was performed by quadrants to know the affected arteries’ origin in the different patterns. (3) Results: The largest and most frequently dissected internal mammary perforator artery was in the second intercostal space. A total of 44.9% of the dissected perforators are located in the upper inner quadrant, compared to 53.5% in the lower quadrants. (4) Conclusions: The upper inner quadrant alone has the most arterial perforators. In contrast, the sum of the two lower quadrants represents the greatest vascularization of the breast, with a small difference between both.
... Reduced gastrointestinal muscle tone is responsible for reflux and heartburn, which are typical symptoms that often occur in the second half of pregnancy [28]. In addition, pregnant women experience an increase in saliva secretion with decreased pH, which can cause an increased risk of tooth decay and bleeding gums. ...
... It reaches its maximum concentration at around 12-14 weeks and then decreases slightly until the end of pregnancy. The hormone helps support the corpus luteum and thus the production of progesterone, which sustains the foetal egg in utero [28,29]. ...
Mental anorexia nervosa is a rare, potentially severe, chronic, and recurrent mental disorder that occurs more often in women than in men, especially during the childbearing years. The disorder is associated with an increased risk of mortality, mainly related to the physical consequences of severe malnutrition and suicide. Malnutrition of the body can cause serious hormonal and somatic problems. Despite significant hormonal disturbances that reduce fertility, a woman with anorexia can become pregnant. A new phenomenon now seen with increasing frequency is pregorexia, an eating disorder associated with pregnancy. It involves the use of dietary restrictions to avoid excessive weight gain during pregnancy. Pregnancy changes the hormonal economy mainly due to the development of the placenta, which secretes many hormones, not just sex hormones. Mental anorexia poses a significant risk to both mother and child if not diagnosed and treated properly. Treatment of anorexia involves simultaneous somatic and psychological treatment. During pregnancy, additional care should be taken to create an optimal environment for the developing foetus. Unfortunately, there is still a lack of research providing guidance in this area. Available studies are mainly case reports or reports focusing on specific clinical situations. It is worth noting that no study to date has attempted a comprehensive assessment of endocrine disruption in pregnant women with anorexia. Recognising the existing knowledge gap on endocrine disorders in pregnant women with anorexia nervosa, a systematic review of the literature was conducted.
... During pregnancy, the breasts undergo the finalization of the developmental processes initiated during puberty, facilitating lactation through anatomical and physiological transformations. These changes are primarily orchestrated by the hormonal actions of progesterone and estrogen [41]. Throughout pregnancy, the expansion and proliferation of ductal and alveolar epithelial cells leads to an increase in ductal side branching and the development of lobulo-alveolar structures. ...
... During pregnancy, the breasts undergo the finalization of the developmental p cesses initiated during puberty, facilitating lactation through anatomical and physiolo cal transformations. These changes are primarily orchestrated by the hormonal action progesterone and estrogen [41]. Throughout pregnancy, the expansion and proliferat of ductal and alveolar epithelial cells leads to an increase in ductal side branching and development of lobulo-alveolar structures. ...
The RANK–RANKL–OPG system is a complex signaling pathway that plays a critical role in bone metabolism, mammary epithelial cell development, immune function, and cancer. RANKL is a ligand that binds to RANK, a receptor expressed on osteoclasts, dendritic cells, T cells, and other cells. RANKL signaling promotes osteoclast differentiation and activation, which leads to bone resorption. OPG is a decoy receptor that binds to RANKL and inhibits its signaling. In cancer cells, RANKL expression is often increased, which can lead to increased bone resorption and the development of bone metastases. RANKL-neutralizing antibodies, such as denosumab, have been shown to be effective in the treatment of skeletal-related events, including osteoporosis or bone metastases, and cancer. This review will provide a comprehensive overview of the functions of the RANK–RANKL–OPG system in bone metabolism, mammary epithelial cells, immune function, and cancer, together with the potential therapeutic implications of the RANK–RANKL pathway for cancer management.
... In contrast, the Breast conditions item (Breastfeeding) in the newborn group, which refers to the anatomical and functional condition of the breast, showed a significant increase in the mean value at the time of discharge. This result can be attributed to the changes the breast undergoes during the first days of lactation: conditions such as hard or warm breasts, tense and flattened nipples, and feeling pain during latching are common during this phase (Alex et al., 2020). However, these conditions require a greater need for support from healthcare professionals (Gianni et al., 2019). ...
... However, it makes no mention of someone who is "actively trying" to become pregnant or someone who may be interested in getting pregnant within the foreseeable future. Because pregnancy increases breast hypertrophy, and because breast surgery has unpredictable effects on the ability to breastfeed, a more inclusive response from the AI might also include those with plans to become pregnant in the immediate future [8,9]. A current study has shown a reduction in the breastfeeding success rate by 41% following breast reduction surgery [10]. ...
Introduction: With advances in AI and machine learning, platforms like OpenAI’s ChatGPT are emerging as educational resources. While these platforms offer easy access and user-friendliness due to their personalized conversational responses, concerns about the accuracy and reliability of their information persist. As one of the most common surgical procedures performed by plastic surgeons worldwide, breast reduction surgery (BRS) offers relief for the physical and emotional burdens of large breasts. However, like any surgical procedure, it can raise a multitude of questions and anxiety.
Methods: To evaluate the quality of medical information provided by ChatGPT in response to common patient inquiries about breast reduction surgery, we developed a 15-question questionnaire with typical patient questions about BRS. These questions were presented to ChatGPT, and the answers were compiled and presented to five board-certified plastic surgeons. Each specialist categorized the response as (1) Appropriate, the response accurately reflects current medical knowledge and best practices for BRS; (2) No, not thorough, the response lacks sufficient detail to be a helpful educational resource; (3) No, inaccurate, the response contains misleading or incorrect information.
Results: A total of 75 survey responses were obtained, with five experts each analyzing 15 answers from ChatGPT. Of these, 69 (92%) responses were determined to be accurate. However, six (8%) responses were concerning to our experts: four (5.3%) lacked detail, and two (2.7%) were found to be inaccurate. Chi-square analysis revealed no statistical significance in the distribution of responses categorized as “accurate” versus “not thorough/inaccurate,” and “not thorough” versus “inaccurate” (p=0.778 and p=0.306, respectively).
Conclusion: While ChatGPT can provide patients with basic background knowledge on BRS and empower patients to ask more informed questions during consultations, it should not replace the consultation and expert guidance of a board-certified plastic surgeon.
... Prolactin and progesterone have important stimulatory and regulatory effects on the luminal secretory epithelial cells of the breast, and together they promote breast development and lactation. The synergistic action of these hormones ensures the normal physiological function of breast tissue [23]. Hormones regulate cellular secretion by binding to cell surface receptors and triggering intracellular signaling pathways. ...
Single-cell sequencing technology provides apparent advantages in cell population heterogeneity, allowing individuals to better comprehend tissues and organs. Sequencing technology is currently moving beyond the standard transcriptome to the single-cell level, which is likely to bring new insights into the function of breast cells. In this study, we examine the primary cell types involved in breast development, as well as achievements in the study of scRNA-seq in the microenvironment, stressing the finding of novel cell subsets using single-cell approaches and analyzing the problems and solutions to scRNA-seq. Furthermore, we are excited about the field’s promising future.
... In addition, fetal growth and position might be linked to this issue, as the results demonstrated a moderate correlation between the temperature of these ROIs and the measured uterine height. Regarding Tsk in the breast region, it is known that changes occur in the mammary duct system during pregnancy, as it branches and expands in response to the increase in estrogen, raising its levels on average from 2 ng/ml during early pregnancy to 22 ng/ml during late pregnancy (Alex et al., 2020). Additionally, Urakova et al. (2020) demonstrated that infrared thermography is effective in determining the location, shape and size of the additional mammary gland lobe in the three days preceding menstruation. ...
... Durante la gestación, la mujer experimenta cambios anatómicos y fisiológicos para lograr la adaptación madre-feto y proveer al feto de los nutrientes necesarios para su adecuado crecimiento y desarrollo, así como para preparar el organismo de la madre para el parto y posteriormente la lactancia (1)(2)(3). La deficiencia de nutrientes se asocia con alteraciones durante la gestación (4-6) y trastornos hipertensivos en el embarazo (7), los cuales son una de las principales causas de morbilidad y mortalidad maternas en todo el mundo. Tan solo la preeclampsia/eclampsia causa alrededor de 50.000-76.000 ...
... Consumption of high-protein meals at lunch can better stimulate the secretion of prolactin [26,27]. More prolactin better stimulates breast milk production [28]. Experiments have demonstrated the speed of whey protein digestion Y HU et al. | ORAL HYDROLYZED WHEY PROTEIN and its effect on gynecologic surgery during the perioperative period [29][30][31]. ...
Objective
This study aimed to investigate the effect of oral administration of hydrolyzed whey protein during the perioperative period of cesarean section on postoperative prolactin levels and breast milk production in mothers.
Methods
triple-blind randomized trial was conducted on women who gave birth in a Chinese tertiary care hospital. Participants were randomly assigned to either the hydrolyzed whey protein or placebo group and were administered the respective substances at specific times during the perioperative period. The primary outcomes were prolactin levels and additional fluid milk intake during specific postoperative periods. Secondary observations included mothers’ subjective preoperative feelings and postoperative exhaust time.
Results
The study found that mothers in the hydrolyzed whey protein group had reduced visual hunger (p=0.002) and anxiety (p<0.001) while having higher neonatal blood glucose levels (p=0.041) compared to the placebo group. This group also had higher prolactin levels (p=0.009) and a reduced the number of milk additions in the first 48 hours of a newborn’s life (No-BreakpNo-Break=0.035).
Conclusion
Hydrolyzed whey protein intake during the cesarean section perioperative period reduces maternal hunger and anxiety, increases serum prolactin levels 3-4 hours after surgery, increases the infant’s blood glucose level 30 minutes after birth, and reduces milk supplementation in the first 48 hours.
Keywords
Cesarean section; Hydrolyzing whey protein; Prolactin
... The areola darkens, the breast enlarges, and the Montgomery glands become more prominent during most pregnancies. When lactation ends, a decrease in prolactin causes a phenomenon known as post-lactational involution [11]. ...
Ultrasound imaging is a commonly used modality for breast cancer detection and diagnosis. The diagnostic role of breast ultrasound has been expanded along with the improvement of high-frequency transducers and digital technology. Vascular assessment has progressed enough to depict normal vascular anatomy of the breast and the lymph nodes. Early detection of breast cancer leads to more effective treatment and fewer deaths. Although mammography is mostly used to detect breast cancer, it is spotted that not all cancers can be seen on mammographic images. Accurate ultrasonography (US) investigations facilitate the surgical approach to a very conservative and cosmetic operation. High-resolution sonography can demonstrate the intraductal spread of tumors and their multiple foci more easily than mammography. Pathologic vessels are seen in almost all the tumors, thus improving US sensitivity for nonpalpable carcinomas. New contrast agents will recirculate enough to search for vascular foci during a thorough investigation of both breasts and nodal stations. In this chapter, we summarize advanced breast ultrasound applications for the diagnosis of breast cancer, including ultrasound elastography, contrast-enhanced ultrasound, 3D ultrasound, automatic breast ultrasound, micropure, ultrasound nomograms, and full non-contact laser ultrasound. We have discussed the limitations of our chapter in the “Discussion” section.
... This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) estrogen elevates prolactin levels. As a result of prolactin's stimulation, the mammary glands are sufficiently developed to produce milk components by the twentieth week of pregnancy [56]. During breastfeeding, women need approximately 500 kcal per day to produce milk. ...
It is well established that breastfeeding provides significant health benefits for both the mother and the infant. The World Health Organization recommends initiating breastfeeding within the first hour after birth and continuing exclusive breastfeeding for 6 months. Successful breastfeeding is influenced not only by the proper physiological preparation of the body and the action of pregnancy-related hormones but also by the mother’s overall health status. However, the role of maternal body composition and metabolic condition in breastfeeding success has received little attention. To better understand the impact of these factors on breastfeeding effectiveness, we reviewed the latest research on this topic, with particular emphasis on the role of hydration and lipid metabolism. Our narrative review indicates that the amount and distribution of water and adipose tissue are crucial for successful lactation and that various hormonal imbalances and metabolic disorders increase the risk of delayed breastfeeding initiation, shortened breastfeeding duration, or insufficient milk production. In light of our findings, measurement methods for assessing described parameters were also introduced. This article aims to review the effects of maternal body composition, hydration status, and metabolic and social factors on lactation and breastfeeding.
... 55 Elevated hormone levels during pregnancy causes the ductal system of the breast to expand and the alveolar epithelium which produces milk increases in size. 56 When breastfeeding stops there is a regression in the breast tissue but there is no substantial reduction of the mammary glands. 57 The lobules in the breast involute as a woman ages with a reduction in the number of alveoli. ...
The Breast Cancer UK—Breast Cancer Prevention Conference addressed risk from environmental pollutants and health behaviour‐related breast‐cancer risk. Epidemiological studies examining individual chemicals and breast cancer risk have produced inconclusive results including endocrine disrupting chemicals (EDCs) Bisphenol A, per‐ and polyfluorinated alkyl substances as well as aluminium. However, laboratory studies have shown that multiple EDCs, can work together to exhibit effects, even when combined at levels that alone are ineffective. The TEXB‐α/β assay measures total estrogenic load, and studies have provided evidence of a link between multiple‐chemical exposures and breast cancer. However, prospective studies using TEXB‐α/β are needed to establish a causative link. There is also a need to assess real‐life exposure to environmental‐chemical mixtures during pregnancy, and their potential involvement in programming adverse foetal health outcomes in later life.
Higher rates of breast cancer have occurred alongside increases in potentially‐modifiable risk factors such as obesity. Increasing body‐mass index is associated with increased risk of developing postmenopausal breast cancer, but with decreased risk of premenopausal breast cancer. In contrast, lower rates of breast cancer in Asian compared to Western populations have been linked to soya/isoflavone consumption. Risk is decreased by breastfeeding, which is in addition to the decrease in risk observed for each birth and a young first‐birth. Risk is lower in those with higher levels of self‐reported physical activity. Current evidence suggests breast‐cancer survivors should also avoid weight gain, be physically active, and eat a healthy diet for overall health.
A broad scientific perspective on breast cancer risk requires focus on both environmental exposure to chemicals and health behaviour‐related risk. Research into chemical exposure needs to focus on chemical mixtures and prospective epidemiological studies in order to test the effects on breast cancer risk. Behaviour‐related research needs to focus on implementation as well as deeper understanding of the mechanisms of cancer prevention.
... (i) Hormonal fluctuations, pregnancy, breastfeeding, and the natural aging process may significantly change the breast size, shape, and elasticity. 7,8 These age-related mammary dynamics manifest in different surgical indications: in younger candidates, juvenile gigantomastia and adolescent macromastia are the main reasons to seek breast reduction. 9 Yet, in the late teens to early twenties, breast development may still be ongoing, thereby rendering it difficult to predict mid-and long-term effects of surgery. ...
Background: Reduction mammoplasty is popular among various age groups, yet the impact of age on postoperative outcomes remains debated. Methods: The ACS-NSQIP (2008-2021) was queried to identify female adult patients who underwent reduction mammoplasty. Patients were categorized into 10-year age brackets (i.e., 18-29, 30-39, 40-49, 50-59, 60-69, and >70 years). We compared age-dependent 30-day outcomes via confounder-adjusted multivariate analyses. Results: 40,958 female patients (mean age: 41 ± 14 years and mean body mass index: 31 ± 6.1 kg/m²) were identified. Complications occurred in 6.4% (n=2,635) of cases, with 770 (1.9%) and 483 (1.2%) patients requiring reoperation and readmission, respectively. 1,706 (4.2%) women experienced surgical complications, while medical complications were generally rare (n=289; 0.7%). Compared to women aged 18-29 years, patients aged 30-39 years (OR: 1.22, p<0.01; OR: 1.05 p=0.51; OR: 1.84, p<0.01), 40-49 years (OR: 1.34, p<0.01; OR: 1.17, p=0.04; OR: 1.54, p=0.03), 50-59 years (OR: 1.45, p<0.01; OR: 1.31, p<0.01; OR: 1.78, p<0.01) 60-69 years (OR: 1.38 years, p<0.01; OR: 1.29, p=0.01; OR: 1.71, p<0.01), and >70 years (OR: 1.25, p=0.18; OR: 1.01, p=0.98; OR: 1.86, p=0.14) all had higher risks of any, surgical and medical complications, respectively. Patients aged >30 years were also more likely to require readmissions and reoperations. Conclusion: Patient age significantly impacts outcomes after reduction mammoplasty, with the lowest risk in patients under 30 years. Importantly, the association between age and postoperative morbidity was not linear. These findings can help guide informed decisions, recognizing that while age is a factor, it is not the sole determinant of risk.
... Toward the end of pregnancy, the mammary organ and mammary cells undergo complex changes in preparation for milk production (lactation). 9 When mammary gland development is interrupted by preterm birth, a mother's ability to initiate and sustain breastfeeding can be impacted. 10 This is because the premature transition into an active lactation state can pose challenges in achieving typical milk volume. ...
Objective
The objective of this review is to synthesize the existing qualitative evidence on the breastfeeding experiences of mothers with hospitalized preterm infants.
Introduction
Breastfeeding is crucial for the well-being and development of preterm infants born before 37 weeks’ gestation. Mothers of preterm infants often face challenges that make breastfeeding particularly complex. Understanding their breastfeeding experience is important for health care professionals as it enables them to provide appropriate support and assistance. The qualitative evidence synthesis regarding the breastfeeding experiences of mothers with preterm infants in hospital settings is a valuable area of research that has not been documented.
Inclusion criteria
This review will consider all qualitative studies that explore the experiences of mothers with preterm infants with breastfeeding and mother’s own milk management for their hospitalized infants. All mothers of preterm infants who provide their own milk to their infants will be considered, regardless of their health and social status.
Methods
This review will follow the JBI approach for qualitative systematic review. The search strategy aims to find both published and unpublished studies with no date limit. A search of PubMed, CINAHL (EBSCOhost), and Embase (EBSCOhost) will be undertaken to identify articles on the topic. Studies published in English will be considered for inclusion in this review. Two independent reviewers will evaluate the methodological validity of the selected papers before incorporating them into the review. Data synthesis will be conducted using the meta-aggregation approach, and synthesized findings will be assessed using the ConQual approach.
Review registration
PROSPERO CRD42024501454
... Os principais motivos relatados pelas mães para a descontinuidade precoce do aleitamento foram "pouca produção de leite" e "retorno ao trabalho". A pega incorreta, com apreensão inadequada da boca do bebê à mama da mãe, dificulta a extração do leite materno, e, consequentemente, o esvaziamento da mama, resultando na diminuição da produção láctea 34 . No entanto, muitas vezes, o que ocorre é a crença materna de que o seu leite está insuficiente ou é fraco, o que não reflete, de fato, a realidade. ...
RESUMO Objetivo: validar conteúdo e aparência de uma cartilha de orientações fonoaudiológicas sobre disfagia para pacientes adultos oncológicos disfágicos. Métodos: trata-se de um estudo metodológico de abordagem mista, desenvolvido para a validação de uma cartilha de orientações. A validação da cartilha, quanto ao conteúdo, foi feita por cinco juízes especialistas e, quanto à aparência, por onze juízes não especialistas. Para a validação utilizou-se o Índice de Validade de Conteúdo para cada item, bem como para todos os itens juntos. Resultados: os juízes especialistas atribuíram valor acima de 80% e de 92,20% para a escala geral de análise. E os juízes não especialistas atribuíram valores acima de 90,9% e de 98,0%, também para a escala geral, sendo considerados excelentes. Conclusão: a cartilha de orientações proposta foi validada segundo conteúdo e aparência. Acredita-se que o referido material possa contribuir para a compreensão do processo saúde-doença, promover o autocuidado e despertar o interesse de outros profissionais da área da saúde para o desenvolvimento de tecnologias educativas em busca de melhores condições de saúde para a população destinada.
... Os principais motivos relatados pelas mães para a descontinuidade precoce do aleitamento foram "pouca produção de leite" e "retorno ao trabalho". A pega incorreta, com apreensão inadequada da boca do bebê à mama da mãe, dificulta a extração do leite materno, e, consequentemente, o esvaziamento da mama, resultando na diminuição da produção láctea 34 . No entanto, muitas vezes, o que ocorre é a crença materna de que o seu leite está insuficiente ou é fraco, o que não reflete, de fato, a realidade. ...
Purpose
to investigate the prevalence of exclusive breastfeeding up to 6 months old in full-term newborns at a public hospital and the main factors associated with early weaning, during the pandemic caused by severe acute respiratory syndrome.
Methods
an observational, cross-sectional study with 98 mothers of full-term babies, conducted from January to August 2021, during the COVID-19 pandemic. The participants answered two structured questionnaires. One was applied immediately after childbirth, with questions on identification and socioeconomic data, obstetric-gynecological background, and current pregnancy and childbirth. The second questionnaire, applied 6 months after childbirth, had questions about the child's feeding status. Statistical tests were used to associate the prevalence of exclusive breastfeeding up to 6 months old and other variables, at the 5% significance level.
Results
16.3% of the babies were exclusively breastfeeding until the sixth month, during the COVID-19 pandemic, in the public hospital where the study was carried out. Exclusive breastfeeding up to 6 months old was not associated with the study variables.
Conclusion
the prevalence of exclusive breastfeeding until the sixth month in full-term babies, in a public hospital, during the COVID-19 pandemic, was 16.3%. None of the variables analyzed was associated with early weaning.
Keywords:
Breast Feeding; Weaning; Rooming-in Care; Infant, Newborn; Maternal and Child Health
... Additional lifecycle phases of females, reproductive hormone characteristics, and considerations that influence health and exercise monitoring In response to a glucose load, increased release of insulin and suppression of glucagon Basal body temperature is likely to be elevated, in the early stages of pregnancy [72] Relaxin increases in the first trimester may be associated with laxity around muscles and joints [73] Increased breast tissue enlargement; therefore, comfort and support for breast tissue may need to be considered more regularly [74,75] The detrimental effects of high levels of cortisol and aldosterone would appear to be mitigated by high progesterone levels [76] Exercise has been noted as an effective method to help regulate glucose and insulin levels throughout pregnancy [77] Daily: Symptoms, wellness, and readiness, sleep Weekly: exercise programme (volume, mode and intensity) and breast support Weekly/bi-weekly: Nutrition ...
Inadequate research on female health and performance; the complexity of the research; low menstrual health literacy of athletes, coaches, and support staff; and ethical and cultural sensitivities are all recognized as barriers to effective health monitoring for females in sports. Frameworks have been developed for academics to follow to help improve the quality of female-specific research. However, a similar resource that enables correct terminology, and use of health monitoring techniques has not been provided for sporting organizations, coaches, support staff or athletes. Therefore, this critical commentary presents a new resource, the Menstrual Health Manager. This resource may be used to determine the level of menstrual health monitoring detail that may be used by organisations, coaches or athletes, and specifies what reproductive health details the data will provide. This resource aims to provide organizations and coaches with a means of understanding the data that inform their decisions for female athletes. Utilization of this resource may aid in the consistent use of terminology and methods for female-specific health monitoring in both sports and research.
... Extensive studies have reported that the dopamine molecule and related processes act as prolactin inhibitors, thereby diminishing lactation (19). Similarly, literature suggests that elevated progesterone levels during pregnancy in mammals serve to prevent prenatal milk loss (20,21). ...
This study aimed to assess the biological and biotherapeutic activities of essential oils derived from the medicinal plants Tanacetum vulgare L., Myrtus communis L. subsp. communis L., and Pimpinella flabellifolia (Boiss.) Benth. Et Hook. ex Drude. Plant samples were systematically collected from the Sivas region of Türkiye. Subsequently, essential oils were extracted using a Clevenger-type apparatus, and their compositions were assessed by gas chromatography–mass spectrometry (GC-MS) analysis. Then, antioxidant activities of the essential oil samples were investigated using β-carotene-linoleic acid and 2,2-diphenyl-1-picrylhydrazyl (DPPH) assays. Furthermore, the antimicrobial activity of these species was assessed via the disc diffusion assay. Finally, the potential effects of the essential oil compositions from these plants on milk production in dairy cows were analyzed through in-silico methods.
... With each menopausal cycle in younger women, the number of lobules increases until age 35. During pregnancy, the number of lobular units can increase ten-fold with ductules differentiating into alveoli [10,11]. ...
The aim of this study was to show for the first time that low-frequency 3D-transmitted ultrasound tomography (3D UT, volography) can differentiate breast tissue types using tissue properties, accurately measure glandular and ductal volumes in vivo, and measure variation over time. Data were collected for 400 QT breast scans on 24 women (ages 18–71), including four (4) postmenopausal subjects, 6–10 times over 2+ months of observation. The date of onset of menopause was noted, and the cases were further subdivided into three (3) classes: pre-, post-, and peri-menopausal. The ducts and glands were segmented using breast speed of sound, attenuation, and reflectivity images and followed over several menstrual cycles. The coefficient of variation (CoV) for glandular tissue in premenopausal women was significantly larger than for postmenopausal women, whereas this is not true for the ductal CoV. The glandular standard deviation (SD) is significantly larger in premenopausal women vs. postmenopausal women, whereas this is not true for ductal tissue. We conclude that ducts do not appreciably change over the menstrual cycle in either pre- or post-menopausal subjects, whereas glands change significantly over the cycle in pre-menopausal women, and 3D UT can differentiate ducts from glands in vivo.
... 55 Notably, as pregnancy proceeds, PRL production also gradually increases because of the estrogen action, which increases PRL gene expression. 80 Additionally, the latest review's absence of a clear connection between PRL and GDM status may be a result of the intricate interactions between PRL and maternal metabolism during pregnancy. 81 Especially with the enormous amounts of PRL being created during pregnancy, the transformation of PRL to vasoinhibin may be decreased, which leads to retinal angiogenesis. ...
Diabetes mellitus (DM) leads to several vascular and neurological complications, including diabetic retinopathy (DR). As the population ages, health problems in certain groups, including children and pregnant women, are drawing more and more attention. Pregnancy is one of the independent risk factors for the development and progression of DR. Pregnancy-induced changes may contribute to or worsen DR, which can cause a tremendous burden on public health. It is essential for pregnant women with DR and their offspring to minimize the risk of vision loss from DR in this population and adverse outcomes by understanding the development and processes behind this process. Thus, we have updated the recent situation of epidemiology, evolution characteristics, risk factors, pathophysiology, pregnancy outcomes for a better understanding of the latest status of DR, helping to improve maternal and neonatal pregnancy outcomes, and promoting health for women with DR.
... Наряду с регуляцией менструального цикла еще одна точка приложения биологических эффектов пролактина -молочная железа. Избыток пролактина стимулирует пролиферативные процессы в молочной железе путем увеличения содержания рецепторов к эстрадиолу в ее ткани, повышения чувствительности клеток пролиферативного эпителия к действию эстрадиола, а также ускорения роста эпителиальных клеток [33,34]. Эти механизмы, в физиологических условиях обеспечивающие подготовку молочной железы к лактации во время беременности, могут вне беременности провоцировать развитие доброкачественной дисплазии молочной железы [3,35]. ...
Real world clinical practice frequently poses the question on the advisability of diagnostic and/or treatment interventions for increased prolactin levels of below 2500 mU/mL (100 ng/mL), which is commonly considered as mild and not unequivocally indicating a prolactinoma. The aim of the review is to critically analyze the body of literature within the last 10 years on clinical and biochemical particulars of patients with mildly increased prolactin levels. We performed the search in Pubmed and RISC (Russian Index of Science Citation) databases with the keywords of “mild hyperprolactinemia” and “women” (or their Russian equivalents). After exclusion of the studies in patients with primary hypothyroidism or treatment with agents inducing prolactin secretion, as well as of clinical case descriptions, we selected 21 original papers with clinical and biochemical data of female patients with mild hyperprolactinemia (prolactin levels of less than 2500 mU/mL or less than 100 ng/mL). Symptoms of mild hyperprolactinemia include menstrual cycle disorders, anovulatory infertility and/or early pregnancy losses, breast disorders, psychoemotional and sexual disorders, and metabolic abnormalities. Repeated testing of prolactin levels to exclude potential stress related to the vein puncture allows for exclusion of 27% to 28% of the patients from further diagnostic work up. Confirmation of persistently increased prolactin levels warrants a magnetic resonance imaging study of the pituitary. Most patients with persistently increased prolactin levels by repeated tests would have pituitary abnormalities (in most cases, pituitary microadenoma). Taking into account the data on negative effects of even mildly increased prolactin levels on reproductive and metabolic health, it is reasonable to administer a first line agent cabergoline at doses ensuring normoprolactinemia. The results of studies indicate that treatment with cabergoline at doses necessary to normalize prolactin levels would lead to regression of menstrual dysfunction, decrease the probability of early pregnancy losses, improve metabolic parameters, promotes restoration of the sexual function, and diminishes the level of depression. This is especially important when planning pregnancy in patients with menstrual cycle disorders, infertility and/or early pregnancy losses.
... For example, rapid hormonal changes cause lactation. 52 Where the entity delivered from the pregnant person's body does not make the transition to neonatal physiology, adapting to the external environment, and is instead isolated to continue gestating ex utero in sterile AAPT, the pregnant person experiences an ending to their pregnancy, but one that is not simultaneous with the 'beginning' described. There, instead, would be a gap between the birthing a pregnant person undertakes (and their transition to the non-pregnant postpartum state) and their child being born. ...
In this paper, we explore how the prospect of artificial placenta technology (nearing clinical trials in human subjects) should encourage further consideration of the loss experienced by individuals when their pregnancy ends unexpectedly. Discussions of pregnancy loss are intertwined with procreative loss, whereby the gestated entity has died when the pregnancy ends. However, we demonstrate how pregnancy loss can and does exist separate to procreative loss in circumstances where the gestated entity survives the premature ending of the pregnancy. In outlining the value that can be attached to pregnancy beyond fetal-centric narratives, we illustrate how pregnancy loss, separate to procreative loss, can be experienced. This loss has already been recognised among parents who have experienced an unexpected early ending of their pregnancy, resulting in their child being cared for in neonatal intensive care unit. Artificial placentas, however, may exacerbate these feelings and make pregnancy loss (without procreative loss) more visible. We argue that pregnancy is an embodied state in which gestation is facilitated by the body but gestation itself should be recognised as a process—and one that could be separable from pregnancy. In demarcating the two, we explore the different ways in which pregnancy loss can be understood. Our objective in this paper goes beyond contributing to our philosophical understanding of pregnancy towards practical-orientated conclusions regarding the care pathways surrounding the artificial placenta. We make recommendations including the need for counselling and careful consideration of the language used when an artificial placenta is used.
... The mammary glands are sufficiently developed to produce these components owing to lactogen stimulation and regulation. Subsequently, myoepithelial cells respond to oxytocin and the contraction of milk-producing alveolar cells, and the female animal experiences a milk-ejection reflex [85]. Enriched pathways showed the remarkably intricate tuning of metabolic and cell development processes converging in milk production in camels. ...
Background
Milk production traits are complex traits with vital economic importance in the camel industry. However, the genetic mechanisms regulating milk production traits in camels remain poorly understood. Therefore, we aimed to identify candidate genes and metabolic pathways that affect milk production traits in Bactrian camels.
Methods
We classified camels (fourth parity) as low- or high-yield, examined pregnant camels using B-mode ultrasonography, observed the microscopic changes in the mammary gland using hematoxylin and eosin (HE) staining, and used RNA sequencing to identify differentially expressed genes (DEGs) and pathways.
Results
The average standard milk yield over the 300 days during parity was recorded as 470.18 ± 9.75 and 978.34 ± 3.80 kg in low- and high-performance camels, respectively. Nine female Junggar Bactrian camels were subjected to transcriptome sequencing, and 609 and 393 DEGs were identified in the low-yield vs. high-yield (WDL vs. WGH) and pregnancy versus colostrum period (RSQ vs. CRQ) comparison groups, respectively. The DEGs were compared with genes associated with milk production traits in the Animal Quantitative Trait Loci database and in Alashan Bactrian camels, and 65 and 46 overlapping candidate genes were obtained, respectively. Functional enrichment and protein–protein interaction network analyses of the DEGs and candidate genes were conducted. After comparing our results with those of other livestock studies, we identified 16 signaling pathways and 27 core candidate genes associated with maternal parturition, estrogen regulation, initiation of lactation, and milk production traits. The pathways suggest that emerged milk production involves the regulation of multiple complex metabolic and cellular developmental processes in camels. Finally, the RNA sequencing results were validated using quantitative real-time PCR; the 15 selected genes exhibited consistent expression changes.
Conclusions
This study identified DEGs and metabolic pathways affecting maternal parturition and milk production traits. The results provides a theoretical foundation for further research on the molecular mechanism of genes related to milk production traits in camels. Furthermore, these findings will help improve breeding strategies to achieve the desired milk yield in camels.
Graphical Abstract
Linda Nazarko looks at how this common cancer can be managed in primary and community care settings
Breast cancer during pregnancy (BCDP) is a rare yet complex condition that presents distinctive diagnostic and therapeutic challenges. This article provides an overview of the incidence, clinical manifestations, diagnostic techniques and treatment strategies pertinent to expectant mothers diagnosed with breast cancer. BCDP occurs in approximately one in every 3000 pregnancies, with a higher prevalence observed in women aged 30 to 40 years old. Nevertheless, as more women put off having children, the incidence of this kind of cancer is predicted to increase much more. After-pregnancy breast cancer is typically triple-negative, being associated with worse prognosis and outcomes. Regardless of the stage at diagnosis, Howlader et al.’s extensive analysis of the Surveillance, Epidemiology, and EndResults (SEER) database, which included 196,094 patients, revealed that triple-negative breast cancer (TNBC) subtype accounted for 9.7% of all cases, being associated with the lowest cancer-specific survival. However, it has been noted that this malignancy is linked to a particular set of genes that can be targeted precisely to treat this fatal illness. In fact, gene-based drugs combined with other cancer treatments are currently being considered for combination therapy. The physiological changes that occur in the breasts during pregnancy can hinder early detection of breast cancer, as the clinical presentation may closely resemble that seen in non-pregnant females. Fortunately, pregnant patients can safely utilize diagnostic imaging modalities such as magnetic resonance imaging (MRI) and ultrasound to evaluate breast masses effectively. Treatment options for breast cancer during pregnancy, which may include chemotherapy and surgical interventions, are designed to optimize outcomes for both the mother and the fetus. To achieve the best results, it is essential to foster multidisciplinary collaboration among neonatologists, obstetricians and oncologists.
Pesticides are widely used to control pests, but their widespread use raises concerns regarding potential health risks for humans. There are several routes through which pesticides can be ingested, inhaled, and absorbed, resulting in acute and long-term health consequences. This systematic review synthesizes the available evidence regarding the health risks and long-term effects of pesticide exposure, with a particular focus on epidemiological and toxicological studies. A systematic review was conducted by searching scientific databases i.e. Scopus, and Web of Science for peer-reviewed articles published between 2000 and 2024. Studies were selected based on their focus on pesticide exposure, health risks, and long-term effects. Meta-analysis was conducted where sufficient homogeneity of outcomes allowed. This review identified consistent associations between chronic pesticide exposure and non-communicable diseases, including cancer, neurological disorders, and endocrine disruptions. An increased incidence of respiratory issues and neurodegenerative diseases was often associated with occupational exposure to pesticides. People exposed for a prolonged or high intensity time period, particularly agricultural workers, were more likely to experience long-term health effects. There are a number of factors that influences the ability to draw definitive conclusions, including variations in pesticide types, exposure levels, and health outcomes. Chronic exposure to pesticides presents significant health risks, particularly for individuals in high-exposure environments like agriculture. While evidence indicates strong associations with several long-term health conditions, additional research is necessary to elucidate dose-response relationships and mechanisms of action. This review underscores the necessity for enhanced regulatory measures and improved safety protocols to mitigate pesticide-related health risks.
Globally, almost nine million women are diagnosed with cancer each year. Nearly every type of cancer affects the female reproductive system. This book is a comprehensive reference for the gynecologic care of women who have been directly impacted by cancer. Providing streamline management approaches to common clinical problems, the text is split into two sections. The first addresses common gynecologic concerns for all cancer patients, with chapters covering topics such as fertility assessment and preservation options, managing sexual health, and cancer and pregnancy. The second section addresses gynecologic considerations based on specific cancer sites including breast cancer, head and neck cancers and leukemias. Representative patient vignettes are included at the end of each chapter to reinforce clinical guidance, along with bulleted 'take home points' for rapid information access.
Purpose
to investigate the prevalence of exclusive breastfeeding up to 6 months old in full-term newborns at a public hospital and the main factors associated with early weaning, during the pandemic caused by severe acute respiratory syndrome.
Methods
an observational, cross-sectional study with 98 mothers of full-term babies, conducted from January to August 2021, during the COVID-19 pandemic. The participants answered two structured questionnaires. One was applied immediately after childbirth, with questions on identification and socioeconomic data, obstetric-gynecological background, and current pregnancy and childbirth. The second questionnaire, applied 6 months after childbirth, had questions about the child's feeding status. Statistical tests were used to associate the prevalence of exclusive breastfeeding up to 6 months old and other variables, at the 5% significance level.
Results
16.3% of the babies were exclusively breastfeeding until the sixth month, during the COVID-19 pandemic, in the public hospital where the study was carried out. Exclusive breastfeeding up to 6 months old was not associated with the study variables.
Conclusion
the prevalence of exclusive breastfeeding until the sixth month in full-term babies, in a public hospital, during the COVID-19 pandemic, was 16.3%. None of the variables analyzed was associated with early weaning.
Keywords:
Breast Feeding; Weaning; Rooming-in Care; Infant, Newborn; Maternal and Child Health
This study aimed to investigate the mechanism of action of myrrh in breast cancer (BC) treatment and identify its effective constituents. Data on the compounds and targets of myrrh were collected from the TCMSP, PubChem, and Swiss Target Prediction databases. BC‐related targets were obtained from the Genecard database. A protein–protein interaction (PPI) analysis, gene ontology (GO) enrichment, and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were conducted on the intersecting targets of the disease and drug. The key targets of myrrh in BC treatment were identified based on the PPI network. The active constituents of myrrh were determined through reverse‐screening using the top 20 KEGG pathways. Macromolecular docking studies, molecular dynamic (MD) simulations, and cell assays were utilized to validate the active constituents and critical targets. Network pharmacology indicated that VEGFA, TP53, ESR1, EGFR, and AKT1 are key targets of myrrh. Pelargonidin chloride, Quercetin, and Naringenin were identified as the active constituents of myrrh. Macromolecular docking showed that Quercetin and Naringenin have strong docking capabilities with ESR1. The results of MD simulation experiments align with those of molecular docking experiments. Cell and western blot assays demonstrated that Quercetin and Naringenin could inhibit MCF‐7 cells and significantly reduce the expression of ESR1 protein. The findings reveal the active constituents, key targets, and molecular mechanisms of myrrh in BC treatment, providing scientific evidence that supports the role of myrrh in BC therapy. Furthermore, the results suggest that network pharmacology predictions require experimental validation for reliability.
Desde a puberdade, menarca, desenvolvimento das mamas, gravidez até a menopausa, doenças significativas afetam as mulheres. uma equipe multidisciplinar poderá assistir da melhor forma esta mulher e ser apoio fundamental no trabalho do médico ginecolog
Background
Evidence suggests that women with breast cancer diagnosed during pregnancy (PrBC) and within 2 years of delivery (PPBC) have similar survival compared to women diagnosed not near pregnancy if adjusted for stage and subtype. To investigate whether this is true for all subtypes and for both pregnancy and post-delivery periods, we examined clinicopathologic features and survival in women with breast cancer by trimesters and 6-month post-delivery intervals.
Materials and methods
Women diagnosed with invasive breast cancer during 1992-2018 at ages 18-44 years were identified in the Swedish Cancer Register, with information on childbirths from the Swedish Multi-Generation Register and clinical data from Breast Cancer Quality Registers. Each woman with PrBC or PPBC was matched 1 : 2 by age and year to comparators diagnosed with breast cancer not near pregnancy. Distributions of stage, grade, and surrogate subtypes were compared. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for breast cancer mortality were estimated using Cox regression.
Results
We identified 1430 women with PrBC and PPBC (181 during pregnancy, 499 during the first and 750 during the second year after delivery). Compared to 2860 comparators, women with PrBC and PPBC in the first year after delivery had a significantly higher proportion of luminal human epidermal growth factor receptor 2 (HER2)-positive, HER2-positive and triple-negative tumours, and more advanced stage at diagnosis. After adjustment for age, year, parity, country of birth, hospital region, subtype, and stage, women diagnosed during the second trimester had a worse prognosis than matched comparators (HR 1.8, 95% CI: 1.0-3.2).
Conclusions
Women diagnosed during pregnancy or within the first year after delivery have a worse prognosis than women diagnosed not near pregnancy due to adverse tumour biology and advanced stage at diagnosis. A worse prognosis for women diagnosed during the second trimester remained after multivariable adjustment, possibly reflecting difficulties to provide optimal treatment during ongoing pregnancy.
Although highly conserved in structure and function, many (patho)physiological processes of the mammary gland vary drastically between mammals, with mechanisms regulating these differences not well understood. Large mammals display variable lactation strategies and mammary cancer incidence, however, research into these variations is often limited to in vitro analysis due to logistical limitations. Validating a model with functional mammary xenografts from cryopreserved tissue fragments would allow for in vivo comparative analysis of mammary glands from large and/or rare mammals and would improve our understanding of postnatal development, lactation, and premalignancy across mammals. To this end, we generated functional mammary xenografts using mammary tissue fragments containing mammary stroma and parenchyma isolated via an antibody-independent approach from healthy, nulliparous equine and canine donor tissues to study these species in vivo. Cryopreserved mammary tissue fragments were xenotransplanted into de-epithelialized fat pads of immunodeficient mice and resulting xenografts were structurally and functionally assessed. Preimplantation of mammary stromal fibroblasts was performed to promote ductal morphogenesis. Xenografts recapitulated mammary lobule architecture and contained donor-derived stromal components. Mammatropic hormone stimulation resulted in (i) upregulation of lactation-associated genes, (ii) altered proliferation index, and (iii) morphological changes, indicating functionality. Preimplantation of mammary stromal fibroblasts did not promote ductal morphogenesis. This model presents the opportunity to study novel mechanisms regulating unique lactation strategies and mammary cancer induction in vivo. Due to the universal applicability of this approach, this model serves as proof-of-concept for developing mammary xenografts for in vivo analysis of virtually any mammals, including large and rare mammals.
Breast surgery has become one of the most common surgeries in females, due to the increasing incidence of breast disease. A detailed understanding of the characteristics of the anatomical structure of the breast and chest wall is an important aspect of complication-free surgery. While the anatomy of the abdominal and thoracic facia is well described, some anatomical details have not been fully explained. Specifically, the different rates of accumulation of postoperative fluid within the upper lateral abdominal quadrant and lower region of the mammary footprint suggest that there is an anatomical predisposition in certain patients. To evaluate this area, the regional anatomy of 525 female patients undergoing radical mastectomy procedures from January 2018 to September 2020 was studied.
The breasts undergo marked physiologic changes during lactation that can make conventional imaging evaluation with mammography and US challenging. MRI can be a valuable diagnostic aid to differentiate physiologic and benign processes from malignancy in patients who are lactating. In addition, MRI may allow more accurate delineation of disease involvement than does conventional imaging and assists in locoregional staging, screening of the contralateral breast, assessment of response to neoadjuvant chemotherapy, and surgical planning. Although the American College of Radiology recommends against patients undergoing contrast-enhanced MRI during pregnancy because of fetal safety concerns, contrast-enhanced MRI is safe during lactation. As more women delay childbearing, the incidence of pregnancy-associated breast cancer (PABC) and breast cancer in lactating women beyond the 1st year after pregnancy is increasing. Thus, MRI is increasingly being performed in lactating women for diagnostic evaluation and screening of patients at high risk. PABC is associated with a worse prognosis than that of non-PABCs, with delays in diagnosis contributing to an increased likelihood of advanced-stage disease at diagnosis. Familiarity with the MRI features of the lactating breast and the appearance of various pathologic conditions is essential to avoid diagnostic pitfalls and prevent delays in cancer diagnosis and treatment. The authors review clinical indications for breast MRI during lactation, describe characteristic features of the lactating breast at MRI, and compare MRI features of a spectrum of benign and malignant breast abnormalities. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Chikarmane in this issue.
Permanent adipose breasts are unique to humans among primates. We propose that permanent breasts, and a preference for them, are an adaptation for pair bonding and a slow life history strategy. This theory predicts that races with a slower life history strategy will prefer breasts to buttocks. To test our hypothesis, we predict preferences for breasts over buttocks from racial admixture and both national and regional average IQ, which we use as an indicator of differences in life history. Measures of Breast-Buttock preference are constructed for nations and subnational regions using the relative frequencies of internet searches on Google, Pornhub and YouPorn for terms related to breasts versus those related to buttocks. Average IQ correlates with Breast-Buttock preference at the national level (r = .76, p < .001), within regions of American countries (r = .85, p < .001), US States (r = .54, p < .001) and US Metro areas (r = .57, p < .001). Controlling for racial ancestry substantially moderated the effect size of intelligence. We consistently found African ancestry to negatively predict breast preference: across countries (r = −.80, p < .001), within US states (r = −.91, p < .001), and US Metro areas (r = −.91, p < .001). These results replicated when using Spanish language search terms within Spanish-speaking countries, suggesting our findings are not peculiar to the English language. Only for US Metro areas did we find a significant effect size for socioeconomic controls.
Keywords: Sex, Breasts, Intelligence, Life history, Race, Ethnicity
Breast cancer (BC) is the most diagnosed cancer worldwide, mainly affecting the epithelial cells from the mammary glands. When it expresses the estrogen receptor (ER), the tumor is called luminal BC, which is eligible for endocrine therapy with hormone signaling blockade. Hormone therapy is essential for the survival of patients, but therapeutic resistance has been shown to be worrying, significantly compromising the prognosis. In this context, the need to explore new compounds emerges, especially compounds of plant origin, since they are biologically active and particularly promising. Natural products are being continuously screened for treating cancer due to their chemical diversity, reduced toxicity, lower side effects, and low price. This review summarizes natural compounds for the treatment of luminal BC, emphasizing the activities of these compounds in ER-positive cells. Moreover, their potential as an alternative to endocrine resistance is explored, opening new opportunities for the design of optimized therapies.
Background:
Evidence suggests that the hormonal milieu of pregnancy is an important determinant of subsequent cancer and other chronic diseases in both the mother and the offspring. Many of the existing maternity and birth cohorts include specimens drawn only once during pregnancy. How well a single blood specimen collected during a pregnancy characterizes exposure to these hormones throughout gestation, and also in subsequent pregnancies, is not well understood.
Methods:
We used serial serum samples from 71 pregnant women (25 primiparous, 25 multiparous, and 21 with two consecutive pregnancies) with natural, complication-free pregnancies and a healthy offspring at term who participated in a population-based screening trial for congenital infections in Finland between January 1st, 1988 and June 30, 1989 and provided a blood sample in each trimester.
Results:
Hormone levels were more strongly correlated between consecutive trimesters of a pregnancy than between the 1st and 3rd trimester (e.g., estradiol, rT1 vs. T2 = 0.51 and rT2 vs. T3 = 0.60, p < 0.01; rT1 vs. T3 = 0.32, p < 0.05). Concentrations of sRANKL remained stable throughout gestation, whereas estradiol, estrone, progesterone, testosterone, prolactin, and osteoprotegerin increased throughout pregnancy. First trimester hormone concentrations explained less of the variation in the third trimester on their own than second trimester hormone levels (e.g. estradiol R(2) T1 = 16 % and R(2) T2 = 42 %). Addition of maternal (e.g., smoking) and/or child characteristics (e.g., sex) improved the accuracy of the 3rd trimester estimates for some of the hormones.
Conclusions:
One hormone measurement in early pregnancy, in conjunction with maternal and fetal characteristics, permits estimation of 3rd trimester hormone concentrations. Therefore, single hormone measurements available from maternity cohorts are suitable to quantify hormone exposure during pregnancy. To our knowledge, we provide the first data on correlations between hormone concentrations both across trimesters of a single pregnancy, as well as between two subsequent pregnancies.
The most important factors in initiation of the cascade of changes in the mammary epithelium that constitute lactogenesis stage II seem to be a prepared mammary epithelium, progesterone withdrawal, maintained plasma prolactin (in most species), and removal of milk from the breast within an undefined interval after birth. Although the molecular mechanisms by which prolactin regulates milk protein synthesis are the subject of intense and productive studies, the specific mechanisms by which progesterone and milk removal interact with the mammary epithelial cell at parturition have not been studied, perhaps because no in vitro model system exists that mimics lactogenesis stage II, or because of the complexity of the changes that must be coordinated during this process, or because of a lack of general understanding of the complex progression of changes in the function of the breast as it goes from the quiescent state of pregnancy to the active secretory state of lactation. With new technologies designed to investigate the biology of complex systems arising from the growing knowledge of the genome of human and animal species and the growing availability of animal and tissue culture models for these processes, physicians can expect a rapid increase in the molecular understanding of lactogenesis in the near future. These fundamental studies must be coupled with good prospective clinical studies if physicians are to obtain a useful, comprehensive understanding of lactogenesis in women.
Milk secretion is a robust process that proceeds normally in at least 85% of women postpartum. Anecdotal evidence suggests that, with assistance in the techniques of breastfeeding, at least 97% of women can successfully breastfeed their infants. The causes of lack of success in breastfeeding are not well understood because, at least in Western societies, when infants fail to thrive on the breast, formula substitution is easy. Although this article is not the place to discuss possible pathologic mechanisms, breastfeeding failure usually occurs at approximately the first week postpartum, and a much better understanding of the mechanisms by which milk secretion is initiated during this period may help researchers to understand why some women have severe problems with lactation. The general understanding of the mechanisms of milk secretion is fairly good, but the regulatory mechanisms at the cellular and molecular levels have not been given adequate attention and are ripe for future investigation. Other areas that require attention are the behavior correlates of breastfeeding and the transfer of drugs and toxins into milk. The latter may have a long-term impact on infant health and should receive increased attention.
Breastmilk is the physiologic norm for infant nutrition. Despite recommendations from major health organizations, many women in the U.S. are not achieving this metric. Understanding breast anatomy and lactation physiology will allow physicians to gain knowledge of the processes, which control lactation enabling physicians to appropriately manage the breastfeeding dyad. The interplay of hormones involved in lactation and milk management affect milk initiation, as well as ongoing milk production (galactopoesis). The unique components of breastmilk that provide protection against infection and chronic diseases also change between and during feeds. Colostrum and the importance of early skin-to-skin after delivery will also be discussed.
Milk is a unique and complete nutritive source for the mammal neonate, also providing immune protection and developmental signals. Lactation is a complex process, proper to the mother and child dyad, and including numerous variables ranging from psychological aspects to the secretory functioning of the mammary epithelial cells, all contributing to a successful breastfeeding. This review gives an integrated overview of the physiology of lactation with a particular focus on cellular and molecular mechanisms involved in milk product secretion and their regulations.
Plastic and reconstructive surgery continues to evolve as new techniques open up new possibilities for the surgeon. In this groundbreaking textbook, contemporary approaches are explained and demonstrated to allow trainee and experienced surgeons alike to understand and assimilate best practice. Containing over 300 outstanding color figures demonstrating surgical practice, an international cast of leading surgeons show the paths to effective plastic surgery technique and outcomes. They cover all the major bases including: Integument; Pediatric Plastic Surgery; Head and Neck Reconstruction; The Breast; Trunk, Lower Limb and Sarcomas; Upper Limb and Hand Surgery; Aesthetic Surgery.
The hypothalamic-pituitary-adrenal axis is central to mammalian reproductive function, including conception, pregnancy maintenance, parturition, and breastfeeding. Pregnancy is associated with substantial physiologic changes within this endocrine axis to meet the demands of pregnancy, which include support of the fetus (volume support, nutritional and oxygen supply, clearance of fetal waste), protection of the fetus (from starvation, drugs, toxins), preparation of the uterus for labor, and protection of the mother from potential cardiovascular injury at delivery. This article reviews the anatomy, embryology, and physiology of the pituitary. The effect of pregnancy on pituitary structure and function, in health and disease, also is discussed.
The mammary gland consists of an extensively branched ductal network contained within a distinctive basement membrane and encompassed by a stromal compartment. During lactation, production of milk depends on the action of the two epithelial cell types that make up the ductal network: luminal cells, which secrete the milk components into the ductal lumen; and myoepithelial cells, which contract to aid in the ejection of milk. There is increasing evidence that the myoepithelial cells also play a key role in the organizational development of the mammary gland, and that the loss and/or change of myoepithelial cell function is a key step in the development of breast cancer. In this review we briefly address the characteristics of breast myoepithelial cells from human breast and mouse mammary gland, how they function in normal mammary gland development, and their recently appreciated role in tumor suppression.
Breast. In: Underwood’s Pathology, 7th edn
- J L Jones
Anatomy and physiology of the breast
- R Farhadieh
- N Bulstrode
- S Cugno