It all depends on the degree of hypoplasia what the risk of insufficient 
milk is. With mild hypoplasia (just the lower quadrants of the breast 
involved, so the breast hangs down like a dog's floppy ear, many mothers 
can make sufficient milk. With mothers with breasts (breasts, not 
nipples) the diameter of a US quarter or an Australian 20 cent piece, 
most will make very little milk. Huggins and Petok did a really useful 
study in Clinical Issues in Human Lactation on the issue. They found 
that almost all mothers with hypoplasia could increase their milk 
production with frequent breastfeeding and pumping over the first 6 
weeks, but that most of those with the severest hypoplasia (type 4) were 
unable to make enough to nourish their babies.

Anticipatory guidance on how to get breastfeeding off to a good start 
and how to assess whether baby is getting sufficient milk is helpful for 
all mothers. For mothers with real risks (previous breast reduction, 
insufficient milk for previous babies, significant breast hypoplasia), 
emphasis on how precious every drop of human milk is for immunological 
protection and trophic (tissue building) functions; on the breastfeeding 
relationship she can have even if she does not make sufficient milk; and 
a balance of information, hopefulness, and empowerment can make the 
difference between her giving up early or continuing to provide breast 
nurturing (and as much milk as she can make) for her baby.
Catherine Watson Genna, IBCLC  NYC

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