Anne, thanks for the case report of the grand multip with lactation failure.
 I, too, have wondered about stretching or settling of lactiferous sinuses.
 The grand multip I reported about now has an older nursling, and while he is
still nursing for comfort etc, she does not perceive any change in milk
supply or his intake; i.e. his larger size has not facilitated milking the
breast.  However, if the function of the first 6 wks of lactation is to 'set
the thermostat' of production for the course of the lactation, then we
probably wouldn't expect much to be changed out at the 2-3 month period.
 Also, this mother began pumping almost immed.  She also used hand-expression
and massage.  Nothing assisted or impacted supply in any way we could
identify. She is somewhat plump, but not dramatically over-weight.  She has
somewhat long breasts and there is a pendulous quality to them, although I
have seen breasts that has been more true of than hers make plenty of milk.
 Her breasts did not strike me as particularly unusual, nor did they palpate
as such.  She remains a tremendous mystery to me.
Barbara Wilson-Clay, BSE, IBCLC
priv. pract. Austin, Tx