I just saw a 31-year-old Asian mom (G2, P1) who was only producing a  
few cc's (measured by pump, baby won't latch) from each breast on Day  
4.  Labor was induced at 41 weeks, and she ended up with a c- 
section.  He only latched on one time in the hospital, was very fussy  
and angry at breast.

She was very edematous in her ankles, and her breasts appeared  
congested also.  She had low progesterone during the beginning of her  
pregnancy and took supplements.  She reports no underlying medical  
conditions, or fertility issues, except that she had one miscarriage  
and then took 10 months to get pregnant again.  I didn't specifically  
ask her about PCOS symptoms.  She is overweight, but so are 40% of  
Americans.

When I spoke with her on Day 6, she was still only getting about 10  
cc per breast, pumping 6-7 times per day.  She is no longer bleeding  
heavily or having other signs of retained placenta.

The reason I am suddenly wondering about hypoplasia is that her  
breasts are not very rounded in the lower quadrants, and they are  
kind of flat and wide, rather than round or pendulous.  I didn't  
notice any asymmetry at the time, or bulbous areolas, or excessively  
wide intermammary space.  We did have a lot of trouble keeping the  
pump flanges on, and milk kept leaking out of the bottoms of the  
flanges.  We were finally able to keep them on by use of a commercial  
pumping bustier (tube top with a zipper in the front and two holes  
for holding the pump flange tunnels).  Her nipples point downward.

I palpated her breasts in a cursory manner, and felt that they were  
firm, not flaccid, but this could have been due to edema.  Her  
nipples are flat, and do not protrude well on pinch test.

Is is within the realm of possibility that this is hypoplasia?  With  
the nonlatching baby and minimal milk supply, she has indicated that  
she will give it another week and then plan to exclusively bottlefeed  
formula.  I encouraged her to talk to her doctor about Reglan and  
Domperidone.

I would appreciate any speculation on this case.

Sincerely,
Lynnette Hafken, MA, LLLL, IBCLC

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