I have seen only a handful of cases of primary lactation  
"failure" (i.e. not a full milk supply) in my very short career (LLLL  
since 2002, IBCLC since 2005).  In 2 of the cases the mothers were  
extremely lean, athletic, and 1 had extremely late onset of menses.   
In both of those cases the mothers were able to bring in a full milk  
supply by diligent pumping, breastfeeding, and supplementing  
judiciously.  In another case I am thinking of, the mother elected to  
quit after getting very low milk production (<1 oz/session) after 2  
weeks of pumping with a Lactina.  Most of the other cases I have seen  
of low milk production can be attributed to ineffective milk removal  
in the early days.  There have been times when I've suspected  
hypoplasia.  If I get the sense that the mother needs to hear  
something concrete about why she has constantly had milk supply  
issues after doing everything right, then I will share with her that  
hypoplasia is a possibility.  I will also tell her that it is  
difficult to diagnose, and that moms with hypoplasia can sometimes  
achieve a full milk supply, and of course that some breastmilk is  
absolutely wonderful.

I saw a mom recently who I thought for sure had hypoplasia (widely  
spaced breasts, more fatty tissue could be palpated than glandular  
tissue, bulbous areolae, minimal breast changes during pregnancy,  
history of milk supply problems x 2, no asymmetry though), but she  
was able to achieve full milk production after about 4 weeks of  
pumping after almost every feeding.  I did share with her my thoughts  
about hypoplasia, and she was very relieved to hear that (a) her milk  
production problems were not her fault, and that (b) she might still  
be able to develop a full supply if she maximized the stimulation.

I really dislike the term "insufficient glandular tissue," because it  
is so negative, much like "incompetent cervix."  I usually explain to  
moms that some breasts have more milk-making tissue than others, and  
theirs may be on the lower end of the spectrum.  It is always  
possible to increase the demand on the system and try to increase  
supply, and how much we can do that is the question.  Some breasts  
respond very vigorously and quickly to increased stimulation, others  
are a more slow-and-steady increase; and others show just a small  
response, which can often be augmented with prescription  
galactogogues.  We just don't know until we try.

Warmly,
Lynnette Hafken, MA, LLLL, IBCLC

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html