There are 3 types of lobules, type 1, 2, and 3 which form at different stages in a woman's development. Large ducts will eventually lead to the terminal duct lobular unit, and these terminal ducts will then branch into grape-like clusters of small acini to form a lobule. The uppermost portion is lined with keratinized squamous cells that abruptly change to the double-layered epithelium (luminal and myoepithelial) of the remainder of the duct and lobule system. Six to 10 major duct orifices open onto the skin surface of the nipple. The normal breast consists of 2 major structures (ducts and lobules), 2 types of epithelial cells (luminal and myoepithelial), and 2 types of stroma (interlobular and intralobular). It is important to learn the normal anatomy and cellular composition of breast tissue to understand the physiologic process of lactation. Other issues of concern regarding lactation include the infants inability to latch, nipple pain, mastitis, or plugged ducts. Women are also encouraged to empty the breast as often as possible, typically every 2 to 3 hours to maintain milk supply. Current recommendations for lactating women is to have a minimum excess of 500 calories per day to meet the caloric demands for milk production. In the post-partum period, some women may experience difficulty with lactation if they have inadequate milk production, poor milk extraction, and insufficient caloric intake to meet demands. Incisions made in the armpit are more favorably for normal breastfeeding whereas, the "smile" incision around the areola increases the woman's risk of having breastfeeding issues. Women who have had breast augmentation may experience issues with lactation and breastfeeding, but this is dependent on the location of the incision. The process of lactation and breastfeeding can be negatively affected by anything that interrupts the normal development of the female breast, or that interferes with the production of milk.
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