Ok all you really wise LC's out there, I'm interested in whether you see these
breasts in your practice, too, and if they have a name and an etiology.

I see the breasts in question probably 3x/year on average (in a hospital with
1200 births/year; I also get some referrals from other places).  They make no
milk or very minimal milk.  They are small and especially unusual in the shape
of the areola--more cone-shaped and distinct rather than looking like a
pigmented part of the breast.  From the side the breasts look more like > than
).  I've seen them enough times now to feel pretty confident that mom will never
have a full milk supply--some of the moms have gone all out with pumping, etc.
for up to two weeks.

Usually there is colostrum present; some mothers have reported being able to
express it during pregnancy.  About the third time I saw breasts like these I
happened to be in for the first feeding, heard lovely swallowing at breast, and
thought all would be well.  It wasn't.  Colostrum petered out, minimal milk came
in despite a voraciously nursing baby, and never increased.  Mothers do report
no breast changes during pregnancy, but other than that there seems to be no
common thread that I have found.

The one I just saw (second one this year) delivered at another hospital, was
sent to us by the Pediatrician--birth wt. of 7-11, down to 6-3 (19% weight loss)
at 9 days.  Was seen in the ER at 8 days for "constipation," parents reported
the doc did a rectal temp, did a cath for urine (none obtained), gave them no
advice and DID NOT WEIGH THE BABY.  It absolutely ASTOUNDS me that so many
parents are now clued into the possibility of dehydration from all that media
hype last summer but that it would not OCCUR to this physician.  At any rate, on
day 12 after 3 days of nursing, pumping after with a hospital-grade electric
pump, and supplementing, mother was obtaining drops with pumping and baby
obtained 0 at breast with before and after weights.  I could palpate no duct
tissue at all.

Two years ago at ILCA I showed Chele Marmet a picture of one of these mother's
breasts, and asked if breasts like that ever made milk in her experience.  She
said yes, they did.  However, I've not seen ANY of this distinctive shape yet
that have.  Is this a Wisconsin phenomena?  I've come to assume that it must be
a developmental defect of some kind--it's like the breasts start to develop
during puberty, but stop for some reason.  Can anyone give me more information?

Becky Krumwiede, RN, IBCLC
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