Mary,
From your description, it does indeed sound like this mother has a
classic presentation of asymmetrical insufficient glandular tissue. Do
you have information on her health history, including "female" issues?
It would be interesting and possibly helpful to know if she had any
menstrual problems, infertility problems, or any other kind of health
problem (most especially endocrinological, like diabetes). It would also
be good to know about the health history of siblings, parents,
grandparents, aunts, and cousins.

In regards to galactogogues, I think that we need to realize that their
initial effect is to attempt to "turbo charge" what glandular tissue is
already in place. It sounds like your mom in question has only a small
amount of glandular tissue, the rest being connective/fatty tissue. This
is like having one small assembly line in the factory instead of a
factory building full of assembly lines. How fast can we make that thing
run and boost production? How much can we get out of one small line,
when there are supposed to be many more?

If you accept this analogy, it becomes clear that the need is for more
assembly lines on top of turbo charging what is there. The question then
is, can this happen, and if so, how? And the unanswered question is,
what *prevented* the normal from happening in the first place-- why did
the body not build a full factory?

We do know that stimulation of the nipple and breast increases
prolactin, and that prolactin "up-regulates" itself and contributes to
building more breast tissue; this is the process and theory behind
induced lactation. Babies and breast pumps can both help. Can
galactogogues do the same?

I honestly have not had a lot of success until this past spring. When it
comes to working with galactogogues, there is not much research, so most
of what is being done is by trial and error. Recently I had a mom who
had udder-shaped breasts that were not filled out, and palpated little
glandular tissue. The mom was highly motivated, and also into natural
remedies, so we decided to pursue a combination of baby breastfeeding,
pumping, and herbal galactogogues. (Tried SNS, but baby stopped eating
altogether, rejected SNS) I recommended More Milk Plus because it is a
combination of the herbs I am most familiar and comfortable with, plus
Goat's Rue, which has a reputation of increasing milk production AND
breast size. The manufacturer recommends that the herbs be used very
frequently, almost every other hour, for the first couple of days, then
back off. What the mother did differently is that she decided to
maintain the high frequency, averaging 8-10 times in 24 hours. It was
not my recommendation, but her original idea and decision. Over 5 weeks
time, her supply gradually increased, but more remarkably, her breasts
filled out! She literally did seem to grow more glandular tissue during
that time. We had started off supplementing the baby 24oz a day to reach
baby's satiety and an approximate 1oz/day gain. When baby was 6 weeks
old, the supplement was down to 3-6oz a day, eventually stabilizing at
3oz (baby happy with that, though gain slowed down a little). This is
the best response I've yet seen in such a case.

This is a case study of one, so you can't draw big conclusions from it.
I think it is worth sharing, however.

~Lisa Marasco, MA IBCLC

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