Bill Klaproth (Host):
So what are some of the maternal complications in breastfeeding and can every
woman successfully breastfeed? And what types of problems and potential
treatments are there? Well, let's find out what Dr. Rachel Yang. She is a
physician at Marin health. She is also a breast surgeon and breastfeeding
medicine specialist.

 This is The Healing
Podcast brought to you by MarinHealth. I'm Bill Klaproth. Dr. Yang, thank you
so much for your time. It is great to talk with you. Can you start off by
giving us a bit of brief background on yourself and talk about your unique
expertise in this area?

Rachel Yang, M.D.: I'm originally from the Seattle,
Washington area. I went to medical school at University of Pennsylvania back in
Philadelphia. And then I moved out with my husband to the bay area where we had
wanted to live for quite some time. And I did my general surgery training at
Stanford. And then I made it to San Francisco for my fellowship in breast
surgical oncology at UCSF.

I subsequently completed my training and certification as an
international board certified lactational consultant, as well as a certified
lactational counselor. And I was thrilled about two years ago to join Dr. Leah
Kaelin's practice at MarinHealth in breast surgery. And I simultaneously started
my own practice in breast feeding medicine.

Host: Well, we are happy you're here Dr. Yang, and thank
you for sharing that with us. So let's talk about breastfeeding. We know that
breastfeeding is beneficial to a newborn baby, but can everyone be successful
at it? I know some women have trouble breastfeeding.

Rachel Yang, M.D.: Yeah, it's certainly not a hard and
fast rule that everyone can be successful. Many people cannot be successful,
whether that be due to something in the breast itself or is something happening
for them hormonally or other psychosocial or home related issues. But those who
really want to breastfeed, with adequate support of a lactation consultant or
breastfeeding medicine specialist; I think our rates of success can be much
higher

Host: so, let me ask you this then, if you have
breastfed once successfully, does that guarantee you can breastfeed your next
child successfully?

Rachel Yang, M.D.: It certainly does not guarantee it.
Absolutely there is an ease to breastfeeding that happens after you've fed one
child and most women find that they are much more comfortable latching their
next baby. They're familiar with the breastfeeding positions. They are familiar
with any complications that they might have occurred the first time around and
are able to pick up on those early on the second time.

So in general, breastfeeding rates are higher with the second
birth. But it doesn't mean it's a sure thing. And there can be new
complications that come around the second time. One that is notorious for
happening more with a second birth or subsequent, is hyperlactation or too much
milk production where the body it's creating an oversupply of milk and that can
lead to complications such as mastitis and abscess.

Host: Right. So when it comes to breastfeeding, is it
all about learning how to do it or are there clinical/physical issues that can
cause problems?

Rachel Yang, M.D.: There absolutely are many physical
and clinical issues, that can cause problems. There is a important piece of
learning how to breastfeed, but a lot of that isn't just about mother, but
maybe more so about some

baby's come out of the womb knowing how to latch and how to
effectively transfer milk from a mother's breasts and other babies either for
known medical reasons or for no known medical reasons cannot immediately
effectively breastfeed or latch . That's especially true with babies that are
born early term or preterm, where they need some time often to learn how to
breastfeed effectively.

And any baby separated from their mother, for reasons such as a
NICU admission won't have to have access to the mother's breasts as much in
those early days. And so needs a bit more and encouragement to understand and
learn how to breastfeed.

Host: Okay. Well, that's interesting to know. So then
what are some of the most common challenges when it comes to breastfeeding?

Rachel Yang, M.D.: I would say that breastfeeding is
very unique to the mother infant dyad and each have their own very unique set
of challenges or if you're lucky enough, yeah, no challenges at all. But, what
I see commonly are the ends of the spectrum, where there are women who
experience low supply or difficulty with milk coming in or not making enough
milk to meet the infant's needs. And that is classified under the term of
hypolactation. And then on the other end of the spectrum, I see a lot of
hyperlactation or oversupply where mom has too much milk. Whether that be
because her body just naturally produces an excess of milk or there is
stimulation in excess of the baby's intake, whether that be from a haka device,
which is a soft silicone pump or an electric pump, or this is her second or
third or fourth baby and the body is in overdrive with milk production.

And a lot of the complications that I see are related to those
over supply challenges. And some of the most common being mastitis, whether
that be inflammatory or infectious, inflammatory mastitis being more common,
actually it does not need antibiotics, most of the time.

The other diseases under the umbrella of oversupply are
glactocele abscess formation, as well as fast let down, are generalized breast
and nipple pain related to the oversupply. And then lastly, there's a very
common complaint of plugged ducts or clogged ducts. And that's something that
is being recently understood quite differently to what we have thought of in
the past. And it really comes from the underlying etiology of inflammation in
the breast. So a lot of my treatment focuses on breast inflammation

Host: So are these diseases/conditions easily treated?

Rachel Yang, M.D.: I'd say again, it depends on the
individual. There's really not oftentimes easy situations where it's, a quick
answer. I think breastfeeding is quite unique compared to other specialties of
medicine where there are two parties involved, the organ system is really
across two humans. There also are factors at play that aren't just biology.
That aren't just an infant's mouth or a mother's breasts. There are the
psychosocial elements of what's happening in the home. Who's supporting the
mother and infant? What are the hopes and wishes and desires of the mother?
What is her experience with breastfeeding in the past? And so there's a lot at
play and the conversations are complex and lengthy, but sometimes the
technical, pharmacologic or medical treatment might be simple, but the
conversations around what's happening might be more complex.

Host: So we mentioned lactation consultants earlier, and
I know that you are a lactation consultant. So do you work with other lactation
consultants in the community?

Rachel Yang, M.D.: Yeah, so of a lot of joy from working
with the lactation consultants in my very local and more regional community. We
collaborate on many challenging cases. I find myself supporting lactation
consultants who are met with really complicated, more tertiary care type
problems with patients. Whether that be someone who's now seen several doctors
around a breastfeeding issue or has something that has really poorly understood
or not been heard of before or more of the run of the mill problems that a
lactation consultant who's newer might just want more support with. I also work
closely with the lactation consultants at my local hospital and some other
regional hospitals to help with programmatic ideas. And I'm thinking about the
structure of how we support breastfeeding aa a system at large. And I enjoy
speaking with various lactation groups on specific topics of interest, many of
which are around the mastitis and inflammatory breast conditions and the
spectrum of disease around over supply.

Host: So then what are some things that would prompt a
mother to seek medical advice when it comes to breastfeeding?

Rachel Yang, M.D.: I would say the first most important
category we'd be pain of the breast or pain of the nipple and pain that's much
greater than expected or out of the ordinary. So I would say that women often
experience discomfort or some amount of pain in the first few days after giving
birth, as the nipples are adjusting the breastfeeding or pumping. But if this
is persisting or really quite severe, definitely seek medical attention. There
are many treatable causes for breast and nipple pain when breastfeeding. And I
do see a lot of that.

Another common reason to seek medical advice when breastfeeding
is if a fever has developed, or the skin of the breast is becoming red. Those
are signs of mastitis and certainly a physician should be notified of this.
Some other concerns that should prompt evaluation are a new lump in the breast
or mass.

And that can be many things, whether it be a fluid collection
or some amount of inflammation. And oftentimes those need imaging such as an
ultrasound to evaluate what's going on in the breast. If there is any concern
about not having enough milk whether that be because baby is not growing
adequately, hopefully a pediatrician would have noticed this and investigated
it. But if there are concerns around baby's intake a milk, if there are
concerns around how much milk is being produced by pumping. And lastly, if
there are concerns about how effectively baby can breastfeed. So if a mom is
noticing that baby breastfeeds for a few minutes, but it's always needing to
get a bottle after. Well, that's the baby who can't effectively transfer milk
from the breast into their mouth and that's something that really benefits from
focused intervention to help identify what problem is at hand

Host: yeah, that is a really comprehensive list. So
thank you for sharing that with us. And it probably goes without saying, better
sooner than later, if you are experiencing any of these things and always worth
a call to the doctor, is that right?

Rachel Yang, M.D.: Yeah. And I think most of these are
not middle of the night emergencies, but certainly getting into a doctor as
soon as you can during the week is something worthwhile. And the sooner you can
intervene on a breastfeeding challenge that better. Babies and moms have a
window of time where they can learn to breastfeed effectively and I always feel
that expediting breastfeeding mothers being seen in my clinic as early as
possible is of utmost importance so that we can intervene earlier and get
people on track.

Host: Dr. Yang, I want to thank you so much for your
time today. One last question. You have a unique set of skills. You're a breast
surgeon, but then you're also a lactation consultant. That is a unique set of
skills. How does that help you serve our community?

Rachel Yang, M.D.: Yeah, I think the realm of
breastfeeding medicine as a whole, is incredibly useful because having
physicians who are not only well-informed about the pathophysiology of
breastfeeding, but also able to intervene in a way that lactation consultants
often don't have the capacity to, specifically with ordering diagnostic tests
and providing medications when appropriate or even recommending or performing a
procedure, that is a huge asset to breastfeeding women, and to our medical
system and community. I'm a bit unique as most breastfeeding medicine
specialists are not breast surgeons. There are a few of us out there. And I
think for us, there's even more of a niche being filled, specifically for
women, who've had breast cancer in the past and wanting to breastfeed in the
future, or have had breast surgery of any kind, whether that be augmentation or
breast reduction, we can give specific help to them. I think my training as a
general surgeon, is very useful in understanding the disease process and the
physiology happening at when there are significant wounds to the nipples,
wounds to the areola when breastfeeding and appropriately treating that. And
lastly, there's a huge need for intervening on some of these more advanced
processes at play with the mastitis spectrum. So when women have a glactocele
or an abscess resulting from prolonged mastitis, it's really a breast surgeon
that's needed. So it's certainly helpful for our patients and our providers and
other disciplines to have a breast surgeon who can intervene on these
processes, but also be informed about what needs to happen and change with the
breastfeeding between the mother and the infant to support healing from an
abscess or a glactocele and prevent another one from a forming in the future.

Host: Well, that certainly does give you an interesting
perspective. And again, it is a unique set of experience and knowledge, to help
you treat your patients for sure. Dr. Yang, this has really been interesting.
Thank you so much for your time.

Rachel Yang, M.D.: Of course, thanks for having me.

Host: And once again, that's Dr. Rachel Yang. And to
learn more, please visit Marinhealth.org. And if you found this podcast
helpful, please share it on your social channels and check out the full podcast
library for topics of interest to you. This is the Healing Podcast brought to
you by MarinHealth.

I'm Bill Klaproth. Thanks for listening.