There is no further risk of complications with myasthenia during lactation (Klehmet 2010), although the course of puerperium may be unpredictable and may worsen in case of infection or short-term disease (Djelmis 2002). Breastfeeding is feasible and by no means contraindicated. In a series of 33 affected mothers with myasthenia, 76% successfully breastfed (Djelmis 2002); The mother should receive much support along with a effective control of her illness (Giwa-Osagie 1981, Camus 1989). Partial interrupted breastfeeding with formula supplementation may be required in those cases of extreme maternal fatigue (Djelmis 2002).Most treatments for myasthenia gravis (see info on pyridostigmine, neostigmine, prednisone, cyclosporine, azathioprine, immunoglobulin, tacrolimus) are compatible while breastfeeding (Skoglund 1978). Approximately 30% of infants may show a transient neonatal myasthenia due to transplacental passage of acetylcholine anti-receptor antibodies (Skoglund 1978); who should be treated and assisted since hypotonia interferes with a satisfactory feeding. There is a higher risk of transient neonatal myasthenia when the mother has not been thymectomized and with a short-term disease (Djelmis 2002, Roth 2006).There is no conclusive evidence on the excretion in significant amounts of acetylcholine anti-receptor antibodies into breast milk (Djelmis 2002) and/or that it would be responsible for cases of transient neonatal myelitis (Brunner 1992). An association between myasthenia and elevated prolactin levels has been found (Lysenko 1998, Tsinzerling 2006) and anecdotally reported with gigantomastia (Scarabin 2010)