There is always that moment of suspense as a mother is dropping her bra 
flaps (drumroll please....).  But as someone here said, sometimes you 
internally say, "Oh no," and yet things work out.  (I personally 
launched into breastfeeding my daughter carrying all sorts of red-flags 
for milk production, which thankfully I didn't know about at the time.)

Here's some of what I say (much stolen from fine LCs everywhere, 
including this list) when suspecting some primary problem with hypoplasia:
""You're probably already suspecting that you're battling with some 
unusual problems.  And with so many factors in you making and the baby 
taking milk, it's sometimes difficult to do the detective work.  How a 
breast looks doesn't always tell us much -- women are built many 
different ways, and breastfeeding tends to work.  But there are certain 
characteristics, such as this very wide spacing, the lack of roundness 
underneath, the unusual shape to the areola and nipple, that are 
sometimes associated with a reduced amount of milk-making tissue.It's 
not just a matter of small breasts -- this is an unusual situation 
called hypoplasia, which is more like an underdevelopment.  This is not 
a yes/no or black/white situation.  You are(generally) already making 
some milk, so there is some tissue available.  In a world where some 
babies never get a *drop* of their mother's milk or a minute at the 
breast, you might feel good about whatever this baby is getting."

""At this point, we don't know how productive we can make the available 
tissue.  As an analogy, if you have a small office, if every person on 
staff is working hard, a lot can get done.  We can talk about some 
strategies.  We can maybe explore your health history for clues.  We can 
work on helping the baby feed more effectively, maybe do some 
supplementing at the breast to increase the stimulation, and we can add 
a hospital-grade pump, to tell your body that you have twins.  There are 
some herbal and prescription medications you can discuss with your 
doctor, which have a reputation for helping with milk production.  It 
may take weeks to see how far we can press the system.  We're lucky we 
have tools for getting milk out of you, and getting milk into the baby, 
so he/she will be happy and growing while we figure this out. At this 
point we can't predict the outcome.  Many women are able to increase 
their milk production, though we can't guarantee a complete supply.  But 
in difficult circumstances, breastfeeding doesn't have to be all or 
nothing.  Many women find that if they sustain that relationship, even 
without the supply they wish they had, they can feel that in the big 
picture they gave their baby a lot through breastfeeding -- maybe more 
than someone who had a full supply, but stopped at two months".
----------------------------------------
This isn't set in stone.  The mother might need time to grapple with the 
"diagnosis" before launching into the remedies.  The discussion should 
be realistic -- a full supply might be impossible.  But it's very easy 
for a mother to hear, "You don't have the right amount of breast tissue 
and you *can't* breastfeed -- end of story,"  She should feel good that 
she's taken active steps and is sitting in a room with a lactation 
consultant, when so many people stop breastfeeding in the first week or 
two. So it seems that we should move quickly in the more hopeful 
approach of what she can do, if the mother is up for it, and battling 
for what is possible.

Margaret Wills, LLLL, IBCLC, Maryland

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