Terri writes: <. She tells me that she has hyperplastic breasts with
insufficient glandular tissue. She says she never had engorgement with
her last baby. The baby and she were separated after delivery for routine
admission and he did not nurse when he did come back to mom. Had
difficulty getting him to latch and was supplementing by time of
discharge. I don't know how she has come up with this diagnosis. She is a
RN and her sister is a M.D. >
I don't know what 'hyperplastic' means or what part of the breast tissue
it might refer to. If she had too little of something, I would think the
word 'hypo' would make more sense. I don't know what connection, if any,
it might have to the diagnosis of insufficient glandular tissue. Since
she is an RN seeking info, and has a sister who is an MD, perhaps it
would be useful to provide them the great illustrated article on breast
shape as a red flag for insufficient glandular tissue that appeared
several years ago in Kathy Auerbach's Clinical Lactation quarterly. Then,
at least some of the info they have on insufficient glandular tissue
would be more realistic.
Of course, this isn't the last word in ISG, and to date, I don't know if
the matter can be sorted out by use of ultrasound after the first
tirmester or after birth. It might be quite possible to have a lot of
fatty tissue with ISG and have a regular contour to the breast. I have
sometimes suspected this. Since she is but 5 weeks pregnant, there is
time to have her notice very carefully if she perceives any breast
changes. I was just reading an article recently (can't remember where)
that glandular cells gradually begin to replace fat cells in the breast
during the first tirmester of pregnancy, and that the size increase or
lack of it may not adequately reflect the important changes taking place
within the breast.
Could it be that they are making this assumption based on a reduced milk
supply only? Insufficient milk removal and insufficient stimulation could
also be responsible for this. Did she per chance have possible symptoms
of retained placental fragment with her first child?? That has seemed to
escaped the notice of several MD's and midwives in our neck of the woods,
and empowering the mothers by giving printed info and and encouraging
them to discuss it with their HCP and/or getting a second opinion is the
main way we have found to help.
I do remember there was an article emphasizing that 1) placental hormones
stimulate much of the development of the ducts and glandular tissues, 2)
not every bit of said tissue from the first pregnancy goes away before
the next pregnancy, especially if they are not too many years apart, and
3) each new pregnancy of course develops a new placenta, and a new chance
to stimulate further growth of some new glandular cells on the total # of
ductal trees with which she herself was born. The gist of the article was
that it was certainly legitimate to encourage this hope in second time
mothers, and in fact, I think there was actually proof. I have definitely
heard many say they had more milk with subsequent pregnancies.
Good luck in educating this mom (and her sister) in the basic
understanding that more frequent milk removal/stimulation will make even
smaller amounts of glandular tissue produce at a faster rate, totaling a
greater quantity per milk-making cell. And that it's not all about the
milk, and the possibility of supplementing at the breast as many mothers
on our list can attest to.
Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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