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