In my large practice with 4-6 thousand visits to the clinic per year, I also
see 3  or 4 moms with insuff. glandular development of the breasts (IGDB) per
year. Niefert described a long tube like breast but I have seen many types
including women only partly affected by this phenom. These moms are usually
aware that there is something different about their breast(s). It is
important to assure mother that it isn't something she's done but the problem
occured when she was a devolping fetus.
Sometimes the size and shape of the breast makes IGDB obvious in other cases
a little detective work is needed. Simple tentitive diagnosis involves a
breast exam with the mom lying flat. The lactating tissue should feel like a
circular mound. There can be areas where the breast is well developed and
areas where a wedge of tissue is missing. The most common areas affected are
the upper and/ or lower quads nearest the breast bone. Confirmation of the
diagnosis is by an ultra sound of the lactating breast. One case we had was a
mom with size DD breasts that showed no substantial lactating tissue inside
the breast on ultra sound. She had a small amount under the areola so a few
drops could be expressed. In cases where a wedge is missing the remainder of
the lactating tissue seems to provide well for the baby.
Of interest is something we've seen in HELLP syndrome where the mother has a
severe postpartum bleed. In one case, the mother's blood loss resulted in
what the physicians called a *pitutary infarct.* She never made milk. Since
that case we have instituted a policy of following the nursing couple for
several weeks if mom's Hgb went below 7 post partum. We've found that they
may take up to ten days or more to get their *milk in.* It's like mom's body
has to get its act  together before it is heality enough to lactate. So we
encourage patience and use a feeding tube in the mean time. We use the
smallest possible tube so the baby doesn't develop a lazy suckle.
We have a lot of elderly (40-45) primigravida's who have a great deal of
difficulty with establishing a milk supply. Often they are in vitro or GIFT
clients. One of our physicians has a theory about the low supply and pitutary
function. He believes that the pitutary may just be old and not capable of
producing sufficient amounts of prolactin.
Anybody else seen this? What do you think?