What Every Physio Should Know About Breasts

By Kym Veale, Lauren Clifton and Melinda Cooper
Reproduced with permission.

Breasts are often the first bodily attribute that defines a human as female. Yet other than their assigned sexual role and valid concerns as a site of cancer their function is cardinal to all members of the class Mammalia. In humans, the breasts operate as the extra-gestate placenta through the specialized system of lactation which in and of itself is part of the human reproductive system. Thus, an understanding of the Lactating Breast is essential to the practice of Women’s Health Physiotherapy.

Women’s Health Physiotherapists are concerned with improving the health outcomes of women throughout their life stages.The large and growing body of compelling evidence points to the indisputable fact that women and their babies who are not exposed to maternal lactation and infant breast-feedingand / or breast-milk feeding are at risk of serious negative health outcomes such as diabetes, cardiovascular disease, obesity, osteoporosis and various cancers. The evidence continues to mount and some researchers wouldcogently argue that an absence of lactation in women who have been pregnant could have more profound adverse health outcomes than a history smoking. By re-positioning lactation and breast-feeding as the biological norm, physiotherapists, as primary contact clinicians can have a powerful role in improving health outcomes across no fewer than two generations.

Life long health outcomes are associated with infant feeding. The Lancet published a meta-analysis of 47 studies comparing 50,302 women with breast cancer to 96,973 women without breast cancer. It was determined that for every 12 months of breastfeeding, a woman’s risk of developing breast cancer reduces by 4.3%. (Collaborative Group on Hormonal Factors in Breast Cancer, 2002). Ovarian cancer risk is increased 1.5-fold for women who artificially feed their infantscompared to women who breastfeed for ≥ 18 months (Danforth, Tworoger, Hecht, Rosner, Colditz & Hankinson, 2007).

Other studies have identified poor health outcomes for women who have not breastfed including inferior glucose levels, lipid metabolism and blood pressure and that these differences persist beyond weaning (Stuebe & Rich-Edwards, 2009). Parous, post-menopausal women who have never breastfed are 28% more likely to develop cardiovascular disease than women who have breastfed for 7-12 months (Schwarz et al., 2009).

In addition to the known risks to women who do not breastfeed, there is also compelling evidence to show that artificially feeding an infant results in a higher risk that the infant will develop lower respiratory tract and gastrointestinal tract infections, diabetes type 1 and 2, otitis media, cardiovascular disease, asthma, sudden infant death syndrome, atopic dermatitis, obesity and leukemia (Ip et al., 2007). A recent study in Denmark suggests that bottle-feeding with formula is associated with a 4.6 fold increased risk of pyloric stenosis. (Krogh C 2012). The risks of negative health outcomes extend beyond the paediatric years.

Supporting women to establish and maintain lactation is an investment in the long-term health of our community. In 2011, the US Surgeon General released the “Call to Action to Support Breastfeeding” which highlights the need to ‘provide education and training in breastfeeding for all health professionals who care for women and children’ (US Department of Health and Human Services, 2011). Ward & Byrne (2011) reiterate the recommendation of the WHO that at least 18 hours’ education for all health professionals who advise pregnant women and mothers should be undertaken.The Public Health Association of Australia advises that nationally consistent training and education for health professionals need to be developed (2010). Our own profession has been advised some 10 years ago that since the primary aim in the immediate postpartum period is the establishment of breastfeeding, Women’s Health Physiotherapists, should remain informed with regard to breastfeeding so that they can support the woman as best as possible (Mantle 2004).

Women’s Health physiotherapists have a responsibility to the mothers’ in their care to be well educated on this subject. Knowledge of human lactation and infant breastfeeding is as important as all and any other knowledge of the human reproductive system.

In addition to informed support, physiotherapists have a pivotal role in providing practical treatment to assist in maintaining breastfeeding. One of the main areas of physiotherapy management is in inflammatory breast conditions including mastitis, a key contributor to women prematurely weaning. Mastitis has a rate of incidence of up to 33% in the puerperium with most episodes occurring in the first 2-3 weeks post-partum (Spencer, 2008). Presentation isa combination of 2 or more signs of inflammation such as local breast pain, erythema, swelling, local temperature increase, systemic fever and malaise. Mastitis in human lactation is still not fully understood and careful assessment is required to determine causative factors. Fetherstone (2003) suggests that the greatest risk factor for developing mastitis is having had a previous episode and thus it is the clinician’s duty to assess and treat effectively to prevent further recurrences.

Early detection and management by a suitably trained physiotherapist can assist in resolving lactation problems promptly, allowing breastfeeding to continue successfully thereby reducing the risks of negative health outcomes from non-human milk feeding. Physiotherapy management includes and is not limited to education to minimize contributing risk factors, application of techniques to reduce inflammation, application of therapeutic ultrasound, positioning for breastfeeding, the use of breast pumps and techniques to improve lymphatic drainage. Much of the armamentarium of physiotherapy practice is relevant to assessing and treating women suffering from inflammatory breast conditions in lactation.

Tory and Rebecca have both undertaken at least 40 hours in post graduate training on the identification and management of conditions of the lactating breast. Please call us on 8331 0552 to discuss any concerns you have with breast feeding.