>>I'm wondering whether more women actually have this condition (in varying
degrees) and are the ones who never ask for help and just say "I never got
much milk so I quit breastfeeding and the baby was much happier..."  These
women don't even bother trying to breastfeed a second baby and certainly
never end up finding out why there were troubles in the first place.  I am
also having a hard time trying to refer these mothers to professionals who
might provide a credentialed diagnosis, because the usual suspects (LC's,
pediatricians, midwives, OB/GYN docs) are all stumped and perplexed by the
suggestion, if they've even heard of hypoplasia at all.<<

Diana,
A mother was just referred to me this past week by another LC. She has a
clean background in every way, primip in her 30's, but small-breasted, about
an A cup. Her breasts did not respond to pregnancy. Very little milk.  In
this particular case we have just discovered low prolactin, but that may or
may not play a role in her lack of breast response to pregnancy, something
we can't tell for sure at this point in the game. The researcher I referred
her to doubted that prolactin replacement would work in her case because of
her lack of pregnancy changes.  I've had many mothers like this; one I was
highly invested in because she goes to my church and wanted nothing more
than a natural childbirth and breastfeeding, and got neither. These two
mothers were very small breasted, but I've had women with larger breasts
also not respond well to pregnancy, ending up with not enough working
lactation tissue. Otherwise, these women were all "normal" looking. 

Then there are mothers who seem to have more obvious hypoplasia. One was a
friend of my daughter's; her mother had completely normal breast development
but this young lady had widely spaced, asymmetric, poorly filled out
breasts. Certainly not a trait inherited from her mother! Two babies, same
results poor results of producing 10mls at a time.  Another came from Mexico
and also had hypoplastic appearing breasts.  I've seen it too many times
now, and no longer feel it is "rare" though it should be.

When I ask these mothers if they have told their doctors about their milk
production problems, probably 80% of the time they have not, so the doctors
are not getting the feedback. And these are only the mothers who come to me,
not the many who simply give up.

I don't believe this is normal in nature. You do not see this kind of
failure in the animal kingdom. But we don't really live "in nature" anymore.
There are an increasing number of studies on environmental contaminants
showing potential problems with reproductive issues, including mammary gland
development and lactation. We have a couple of studies that have come out
examining mammary gland development problems in certain subpopulations, such
as a particular agricultural group. One abstract I just read found problems
with mammary gland development related to the ingestion of a popular
cultural drink with alcohol, and noted that animals studies have shown
problems with mammary gland development with significant/chronic alcohol
consumption. The information I've read chills me to the bones some days, and
nothing surprises me any more except those who insist that this phenomenon
is still very rare. 

Regarding diagnosis, there is so little info out there, and the medical
community especially doesn't know what to do with this. I will ask for a
couple of hormone tests, but the truth is that hormones are only half the
picture. Environmental contaminants often affect hormone *receptors,* which
are harder to measure because they are located on target organs and don't
flow through the blood. Everything can come back "normal" but not be, and we
can't measure that easily, let alone know what to do about it. 

Hardest of all, hardly anyone seems to care other than how to compensate
with plastic surgery. 

Nevertheless, the more we talk, the more we point out the obvious to the
medical community, the more we will raise awareness. I am hoping for someone
with the right back ground to take interest and take the work further. In
the meantime, I work with what is available to me and hope for some results.
Not satisfying, but that's where we are at right now. 

Lisa Marasco MA IBCLC

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