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The use of ultrasound to identify milk ejection in women - tips and pitfalls.

Geddes DT - Int Breastfeed J (2009)

Bottom Line: At milk ejection, the echogenic duct walls expand as milk flows forward towards the nipple.Milk flow appears as echogenic foci rapidly moving within the milk duct.This paper provides a detailed description of the ultrasound technique used for the detection and reviews nuances associated with the procedure.

View Article: PubMed Central - HTML - PubMed

Affiliation: M310, Biomedical, Biomolecular and Chemical Sciences, Faculty of Life and Physical Sciences, The University of Western Australia, Western Australia, Australia. donna.geddes@uwa.edu.au.

ABSTRACT
Diagnostic ultrasound imaging of the breast has been limited principally to the abnormal, non-lactating breast. Due to the rapid improvement of imaging technology, high-resolution ultrasound images can now be obtained of the lactating breast. Ultrasound scanning techniques, however, require modifications to accommodate the breast changes that occur in lactation. Furthermore, the function of the breast with regard to milk ejection can be assessed with ultrasound by identification of milk duct dilation and milk flow. At milk ejection, the echogenic duct walls expand as milk flows forward towards the nipple. Milk flow appears as echogenic foci rapidly moving within the milk duct. This paper provides a detailed description of the ultrasound technique used for the detection and reviews nuances associated with the procedure.

No MeSH data available.


Related in: MedlinePlus

Photograph of the right areola of a lactating woman prior to milk ejection. The milk ducts directly superior to the nipple are very superficial and can be seen as bulging under the skin.
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Figure 1: Photograph of the right areola of a lactating woman prior to milk ejection. The milk ducts directly superior to the nipple are very superficial and can be seen as bulging under the skin.

Mentions: Lactocytes (secretory mammary epithelial cells) line the alveoli of the lactating breast and synthesize milk. In women, the greater portion of the milk is stored in the alveolar region until required by the suckling baby. Milk ejection is the process by which milk is forced into the larger ducts to become available for removal by either the infant or breast pump. Stimulation of the nipple causes the release of oxytocin from the posterior pituitary into the bloodstream. Oxytocin then binds to receptors on the myoepithelial cells that surround the milk-filled alveoli, causing them to contract and thereby forcing the milk into the milk ducts [6,7]. Milk ejection is a transient phenomenon lasting between 45 seconds and 3.5 minutes [8-10]. Oxytocin is therefore released in a pulsatile fashion with multiple ejections usually occurring during either a breastfeed or pumping session [9,10]. Milk ejection is critical for successful breastfeeding and continued milk synthesis [11], as little milk (approximately 2.7 mL; range 0 to 10.3 mL) can be removed prior to milk ejection [12]. Typical maternal sensations of milk ejection include tingling, pins and needles, pain or pressure in the breast and milk flow from the breast. Occasionally, the mother may experience systemic symptoms such as nausea, warmth or thirst [6,13]. These sensations are often strongest for the first milk ejection, waning for subsequent ejections during the breastfeed/pump. In the absence of sensations of milk ejection during breastfeeding the infant may change its sucking behaviour to a regular, more rhythmic pattern, whereas during pumping, milk jets may be observed. In addition, we have noticed that the areola region becomes more full and tense and this appears to be more marked in mothers with larger (> 4 mm) superficial ducts (Figures 1 and 2; Additional file 1). Methods for the detection of milk ejection have been developed, such as frequent sampling of maternal blood to detect oxytocin [9] and measurement of intra-ductal pressure by the cannulation of a milk duct through a nipple pore [14]. Detection of an increase in pressure is associated with the release of oxytocin and milk ejection. However both of these procedures are invasive and stressful. It is possible that the stress associated with the procedure itself may impair milk ejection by inhibiting the release of oxytocin, resulting in decreased milk yield [15]. In addition, measurement of intra-ductal pressure carries the added risk of the introduction of infection to the breast. Alternatively, ultrasound is a convenient, cost-effective method of confirming milk ejection during either breastfeeding or breast pumping [4], particularly if the infant/pump is removing very small quantities of milk.


The use of ultrasound to identify milk ejection in women - tips and pitfalls.

Geddes DT - Int Breastfeed J (2009)

Photograph of the right areola of a lactating woman prior to milk ejection. The milk ducts directly superior to the nipple are very superficial and can be seen as bulging under the skin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2710318&req=5

Figure 1: Photograph of the right areola of a lactating woman prior to milk ejection. The milk ducts directly superior to the nipple are very superficial and can be seen as bulging under the skin.
Mentions: Lactocytes (secretory mammary epithelial cells) line the alveoli of the lactating breast and synthesize milk. In women, the greater portion of the milk is stored in the alveolar region until required by the suckling baby. Milk ejection is the process by which milk is forced into the larger ducts to become available for removal by either the infant or breast pump. Stimulation of the nipple causes the release of oxytocin from the posterior pituitary into the bloodstream. Oxytocin then binds to receptors on the myoepithelial cells that surround the milk-filled alveoli, causing them to contract and thereby forcing the milk into the milk ducts [6,7]. Milk ejection is a transient phenomenon lasting between 45 seconds and 3.5 minutes [8-10]. Oxytocin is therefore released in a pulsatile fashion with multiple ejections usually occurring during either a breastfeed or pumping session [9,10]. Milk ejection is critical for successful breastfeeding and continued milk synthesis [11], as little milk (approximately 2.7 mL; range 0 to 10.3 mL) can be removed prior to milk ejection [12]. Typical maternal sensations of milk ejection include tingling, pins and needles, pain or pressure in the breast and milk flow from the breast. Occasionally, the mother may experience systemic symptoms such as nausea, warmth or thirst [6,13]. These sensations are often strongest for the first milk ejection, waning for subsequent ejections during the breastfeed/pump. In the absence of sensations of milk ejection during breastfeeding the infant may change its sucking behaviour to a regular, more rhythmic pattern, whereas during pumping, milk jets may be observed. In addition, we have noticed that the areola region becomes more full and tense and this appears to be more marked in mothers with larger (> 4 mm) superficial ducts (Figures 1 and 2; Additional file 1). Methods for the detection of milk ejection have been developed, such as frequent sampling of maternal blood to detect oxytocin [9] and measurement of intra-ductal pressure by the cannulation of a milk duct through a nipple pore [14]. Detection of an increase in pressure is associated with the release of oxytocin and milk ejection. However both of these procedures are invasive and stressful. It is possible that the stress associated with the procedure itself may impair milk ejection by inhibiting the release of oxytocin, resulting in decreased milk yield [15]. In addition, measurement of intra-ductal pressure carries the added risk of the introduction of infection to the breast. Alternatively, ultrasound is a convenient, cost-effective method of confirming milk ejection during either breastfeeding or breast pumping [4], particularly if the infant/pump is removing very small quantities of milk.

Bottom Line: At milk ejection, the echogenic duct walls expand as milk flows forward towards the nipple.Milk flow appears as echogenic foci rapidly moving within the milk duct.This paper provides a detailed description of the ultrasound technique used for the detection and reviews nuances associated with the procedure.

View Article: PubMed Central - HTML - PubMed

Affiliation: M310, Biomedical, Biomolecular and Chemical Sciences, Faculty of Life and Physical Sciences, The University of Western Australia, Western Australia, Australia. donna.geddes@uwa.edu.au.

ABSTRACT
Diagnostic ultrasound imaging of the breast has been limited principally to the abnormal, non-lactating breast. Due to the rapid improvement of imaging technology, high-resolution ultrasound images can now be obtained of the lactating breast. Ultrasound scanning techniques, however, require modifications to accommodate the breast changes that occur in lactation. Furthermore, the function of the breast with regard to milk ejection can be assessed with ultrasound by identification of milk duct dilation and milk flow. At milk ejection, the echogenic duct walls expand as milk flows forward towards the nipple. Milk flow appears as echogenic foci rapidly moving within the milk duct. This paper provides a detailed description of the ultrasound technique used for the detection and reviews nuances associated with the procedure.

No MeSH data available.


Related in: MedlinePlus