In the plastic surgery lit (G Williams, S Hoffman: Mammoplasty for tubular
breasts, Aesthetic Plastic Surg 1981; 5(1):51-56) a large areola placed far
forward in the cone of a hypoplastic breast is described as a marker for
abnormal breast development.  Huggins, Petok, and Mireles published a study
(Markers of Lactation Insufficiency:  A study of 34 mothers, Current Issues
in Clinical Lactation 2000; 25-34) that expands upon previous
classifications of breasts by physical characteristics.  Their paper
describes the tubular breast as including:  "areolar enlargement, herniation
of the glandular tissue into the nipple-areolar complex, asymmetric
expression of the deformity..."  85% of the mothers they prospectively
followed who had abnormal breast appearance had difficulty producing all the
milk needed by her baby in the first week of life.  Some of these mothers,
with very careful management and a lot of pushing (pumping, galactagogues,
etc) managed to stabilize at full production out about a month postpartum.
While the sample size is small,  these women with breast markers for
hypoplasia were at risk for low milk production.  This is an important
clinical finding because it means this women need closer follow-up and their
babies need frequent weight checks to make sure they are doing ok.  The
counseling aspect needs to be sensitive, as body image and self-esteem can
impact a mother's decisions about breastfeeding.  Mothers need information
so they can make good decisions, but tact is critical.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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