Q&A: trouble breastfeeding from hypoplastic breasts

Jennifer writes:

"I diagnosed myself with PCOS and had my FP agree with me. I had trouble breastfeeding. After a week I had no milk or not enough. I struggled with it and tried different things. The LLL I went to thought that it could be a glandular problem. Anyone know where to go to see if it is in fact a glandular problem? The Ob/Gyn I went to see this month had no clue about it."

Then she referred me to a post she wrote about her breastfeeding problems. One sentence in particular jumped out at me:

"I found out that with the mild PCOS that it is possible that I have hypoplastic breast where my breast tissue itself has never fully developed."

I think it's highly probable that your milk production problem is a function of your PCOS and that you may have hypoplastic breasts and that the two may be linked.

Here's a site with definitions of and a photo of hypoplastic breasts (scroll down to "Tubular Hypoplastic Breasts"). I don't love this site, and the photos are not at all work-appropriate unless you work at a women's health initiative or nudie magazine, but it was the only place I could find photos. A good description of the problem of hypoplastic breasts is here.

One PCOS researcher, Lesa Childers, thinks the cause of breast hypoplasia may be hormonal, which means it could be linked to PCOS. Read an interview with her here.

If you can't find anyone in your area who can diagnose you with hypoplastic breasts, I'd call Dr. Mona Gabbay, who is a medical doctor specializing in breastfeeding and an IBCLC lactation consultant. She works from Westchester, New York, but if anyone knows how to get you diagnosed in your area it will be her. I know a few women who have worked with her who say she's amazing.

Mona Gabbay, MD, IBCLC
Breastfeeding Medical Consultants of Westchester
145 Seventh Avenue
Pelham, NY 10803

Tel:  (914) 632-7999

What I understand about having hypoplastic breasts is that since the tissue is undeveloped, you will "max out" at a certain amount of milk production. This means that women with breast hypoplasia will have to supplement with formula, and they'll have to pump and take supplements (either natural ones like fenugreek, or chemical ones like Reglan or Domperidone) to get up to their own personal full production. But they can still nurse partially, and any nursing you can do is good. Nursing one baby and then going through the hormone bath of another pregnancy also increases the capacity of the breasts so that a woman is likely to produce more milk for a second baby than for a first baby, and even more still for any subsequent babies.

If you know you have hypoplastic breasts before the baby arrives, you'll be prepared to do the work to get your supply as high as it will go, and you'll also know that you'll need to supplement. So if you have any suspicions, check out the websites I linked earlier, and find an LC who has experience with breast hypoplasia who can help you through the first few weeks to get your systems down.

And now for the hypoplasia success stories of women I know personally:

A. is a woman I met in the breastfeeding support group I went to when my first son was tiny. She was using the supplemental nursing system (SNS or Lact-Aid) to supplement her milk with formula as she nursed him (which did double-duty by simulating her breasts to produce more milk while supplementing). She used the SNS for over a month, then went to a system of nursing then topping him off with formula in a bottle. She nursed him until he was 6 months old, when she went back to work at a job that didn't allow her to pump.

B. is an old friend of mine whose son was slightly premature and in the NICU for a week. She thought her supply issues were a result of the NICU experience or a weak suck from being early, but fortunately her LC referred her to Dr. Gabbay, who diagnosed her with hypoplasia within the first 5 minutes of the consultation. They explored the option of using Reglan or Domperidone to try to increase her maximum production, but because of B's medical history they decided against it. B. alternated nursing and formula feeding until her son was around 10 or 11 months old, at which point he was eating enough solids that she could keep up with his consumption on her own and she dropped the formula.

C. is a relative of mine with three grown children. I happened to mention B's hypoplasia to my mother, and she gasped. "That sounds exactly like C.'s breasts. I bet that's why C. had to supplement with her kids!" she said. My mom called C. to tell her about hypoplasia, and C. started crying, because for 30 years she thought it was something she'd done wrong that had prevented her from having a full supply. She'd nursed each of her kids for over a year, supplementing with formula the whole time.

Jennifer, I hope you can find an LC in your area who can diagnose your situation. If you have another child you will likely have more milk, but even if you don't have any more children, it will give you closure to know why you had supply problems.