The Influence of Breast Surgery, Breast Appearance, and Pregnancy-Induced Breast Changes on lactation Sufficiency as Measured by Infant Weight Gain

Authors

  • Marianne Neifert M.D.,

    Corresponding author
    1. Marianne Neifert is Medical Director and Joy Seacat is Associate Director of the Lactation Program at AMI Saint Luke's Hospital in Denier, Colorado. Sandra DeMarzo is Project Manager for the NICHD research grant HD23091 that funded this study. Miriam Orleans, Marilyn Leff, and David Young are members of the Department of Preventive Medicine and Biometrics at University of Colorado School of Medicine.
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  • Sandra DeMarzo C.H.A., M.S.,

    1. Marianne Neifert is Medical Director and Joy Seacat is Associate Director of the Lactation Program at AMI Saint Luke's Hospital in Denier, Colorado. Sandra DeMarzo is Project Manager for the NICHD research grant HD23091 that funded this study. Miriam Orleans, Marilyn Leff, and David Young are members of the Department of Preventive Medicine and Biometrics at University of Colorado School of Medicine.
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  • Joy Seacat C.H.A., M.S.,

    1. Marianne Neifert is Medical Director and Joy Seacat is Associate Director of the Lactation Program at AMI Saint Luke's Hospital in Denier, Colorado. Sandra DeMarzo is Project Manager for the NICHD research grant HD23091 that funded this study. Miriam Orleans, Marilyn Leff, and David Young are members of the Department of Preventive Medicine and Biometrics at University of Colorado School of Medicine.
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  • David Young M.S.,

    1. Marianne Neifert is Medical Director and Joy Seacat is Associate Director of the Lactation Program at AMI Saint Luke's Hospital in Denier, Colorado. Sandra DeMarzo is Project Manager for the NICHD research grant HD23091 that funded this study. Miriam Orleans, Marilyn Leff, and David Young are members of the Department of Preventive Medicine and Biometrics at University of Colorado School of Medicine.
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  • Marilyn Leff M.S.W., M.S.P.H.,

    1. Marianne Neifert is Medical Director and Joy Seacat is Associate Director of the Lactation Program at AMI Saint Luke's Hospital in Denier, Colorado. Sandra DeMarzo is Project Manager for the NICHD research grant HD23091 that funded this study. Miriam Orleans, Marilyn Leff, and David Young are members of the Department of Preventive Medicine and Biometrics at University of Colorado School of Medicine.
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  • Miriam Orleans Ph.D.

    1. Marianne Neifert is Medical Director and Joy Seacat is Associate Director of the Lactation Program at AMI Saint Luke's Hospital in Denier, Colorado. Sandra DeMarzo is Project Manager for the NICHD research grant HD23091 that funded this study. Miriam Orleans, Marilyn Leff, and David Young are members of the Department of Preventive Medicine and Biometrics at University of Colorado School of Medicine.
    Search for more papers by this author

Address correspondence to Marianne Neifert, M.D., The Lactation Program, AMI St. Luke's Hospital, 601 East 19th Avenue, Denver, CO 80203.

Abstract

ABSTRACT: We conducted a prospective study of the associations between several biologic and surgical breast factors and the onset of lactation in 319 healthy, motivated, primiparous women who were breastfeeding term, healthy, appropriate for gestational age or large for gestational age infants. During the last trimester of pregnancy, subjects' breasts were examined for surgical incisions, size, symmetry, and nipple protuberance, and women estimated their prenatal breast enlargement. At two visits in the first two weeks postpartum, infants were weighed naked, and mothers reported the magnitude of postpartum breast engorgement when their milk came in. Breastfeeding was evaluated at each visit, and interventions were recommended for problems, with emphasis on maximizing milk yield. Lactation was deemed sufficient when an exclusively breastfed infant achieved an average weight gain of 28.5 g or more per day between the two visits. Infants gaining less than 28.5 g per day with breast milk exclusively, and those requiring formula supplement returned for a third visit at or before 21 days of age, when final lactation outcome was assessed based on weight gain between the second and third visits.

Within three weeks postpartum 85 percent of the mothers achieved sufficient lactation, whereas 15 percent had persistent milk insufficiency despite intensive intervention. Of the study population, 6.9 percent had undergone previous breast surgery. Women with periareolar breast incisions were nearly 5 times more likely to have lactation insufficiency than were those without surgery (relative risk [RR] = 4.55; 95 percent confidence interval [CI] = 2.21–9.43; P < 0.001). Insufficient lactation was significantly associated with minimal prenatal breast enlargement (P < 0.02) and minimal postpartum breast engorgement when milk came in (P < 0.001). Although not statistically significant, women with inverted nipples were more likely to have lactation insufficiency compared with those with normal nipples (RR = 2.94; 95% CI 1.05–8.20; P= .07). The findings from this study indicate that certain biologic and surgical breast variables are associated with lactation insufficiency.

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