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Date: | Thu, 11 Aug 2005 11:38:55 -0400 |
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Jen,
What complicates the situation is that women with breast hypoplasia
(undergrowth) can respond to stimulation by increasing supply. For some
women, there is so little glandular tissue that the maximum supply is
small, for others, a larger increase is possible. Petok and Huggins'
study in Clinical Issues in Human Lactation 2000 is still very useful
for determining whether or not any particular mom has hyperplasia, and
for predicting outcomes.
I agree that the photo 162 in the 2nd edition of the Breastfeeding Atlas
is a marginal case. Palpation is as important as observation when
deciding whether glandular tissue is sparse or not. There is a
difference in feel between understimulated breasts and underdeveloped
breasts. This woman (162) has a somewhat wide intramammary spacing (a
sign that increases suspicion of sparse glandular tissue), but the shape
of her breast is normal. There is a nice round contour. Small breasts
that are normal may be flat to the chest, but there will be that nice
round shape, and the breast will cover the correct number of ribs. There
is also generally asymmetry between the breasts in hypoplasia cases that
helps us distinguish them from small normal breasts, but not always.
My rule of thumb is if I'm not sure, I keep my mouth closed and make
sure the mom gets extra follow up. If it's clearly hypoplasia, I gently
discuss the implications with the mom, and always hold out hope for
increased milk. Then we get to supplementing at the breast, usually with
a Lact-Aid, and stimulating supply as agressively as mom wants to and is
able to.
Catherine Watson Genna, IBCLC NYC
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