I read a surgical reference once that referred to that as "herniation of
the breast tissue into the areola".

I have it figured out that it is associated with less connective tissue
in the subareolar area, which is not necessarily all bad news, as it
allows access to the lactiferous sinuses quite easily. In the situation I
saw, edema did not collect in that area, nor was there a "fibrous"
quality to the tissue that I frequently find in other mothers that makes
latching problems.

I have had one patient with them, though she clearly had tubular breasts.
Despite that, they fit well into the flanges for the Ameda-Egnell pump,
as the breast definitely distorted to conform to the flange during
pumping, and must have just fit great over the sinuses, because pumping
was very efficient.

Though there were complicating social factors (family attitudes, bottles,
early return to school/work) that discouraged long-term breastfeeding,
the oftener and more thoroughly she pumped during the period I followed
her, the breast responded by producing (and transferring) milk most
effectively. I was unable to estimate actual daily quantity because her
social situation precluded close follow up and included many bottles (and
scrambled egss, etc.) given to her baby in her absence.

So my first thought would be pumping at frequent intervals, even for
short times and even if yield isn't much at first, for early stimulation
of the largest possible supply in the first 4-6 weeks, even when the babe
seems to be "back on his feet" and nursing robustly. And breast
compression during feeding if babe "rests".

It won't hurt to evaluate closely the tongue, suck, etc. either, just to
be sure the unusual look of the mom's breast doesn't distract from other
possible factors that effect quantity produced.

If there seems the possibility of fewer lobes of glandular tissue, this
requires the individual alveolus to be emptied oftener so there is faster
"turnaround time" within the alveolus to produce (as happens in other
moms nursing multiples.)

<IMHO these babies act like mom is giving fairly large amounts of skim
milk
as you will likely
observe early swallowing in these babies at breast in the first few days
too, more so than
the average. I'd have to guess a lack of fat content and calories as
evidenced by lack of
stooling and frantic behavior often right after a feeding in addition to
quantity.>

Each individual alveolus that she possesses still manufactures all
components of breastmilk, including fat within in each milk making cell.
There are no separate cells that produce any one component of breastmilk.


The unusual contour of her breast may affect the quantity and the
transfer of her milk, but I don't believe the total quality of an
appropriately collected sample will show a lack of fat. A
lactoengineering challenge here.

Jean
**************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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