I have worked with only a small number of women with Glandular Insufficiency,
or Tubular Breast.
In both cases, neither women knew what was going on before the
Consultation. One woman's first baby was hospitalized with dehydration, when
she attempted to exclusively breastfeed the child, and was not given proper
instructions on how to assess intake by her HCP. Both women women had
long, tube shaped breasts, large areola, pointing toward the ground, late onset
menarche and late breast "development" and erratic menstrual cycles.
I will use an amalgam as one case, changing some details, as although I
obtained HIPPA from both women, I do not want to identify them.
In one case, I walked into the house, and saw a rather cadaverous looking
infant sitting in a car seat. Mom said, "He doesn't look good, does he?" I
weighed the baby, who was more than a lb under his release weight and was
having less than 3 wet diapers per 24 hrs, and few stools.
We attempted to latch him on and the child went willingly to breast. On
palpation, I detected virtually no ductal tissue at all. The breast appeared to
be made of nearly all fatty tissue, and there was only a few swallows for every
dozen sucks or so. I had never seen a mother, only 7 days pp with such lack
of normal ductal tissue. (We expect good, working ducts, which fill and
respond to suckling and to compression.) I attempted Breast Compression, but
there was little to compress. The mom made a joke that "I could put him on
the floor." as her breasts hung down so far. :( (Neither of these women had
had any surgery on their breasts.) After a few minutes, trying several
strategies, it was pretty obvious what was going on. And the baby was
becoming fatigued. I weighed the baby, and he had lost a half oz from his
efforts. The mother began to cry, I felt terrible, and we talked about her
options.
I, at the time, talked to some people on Lactnet, and although a few
suggested Domperidone or herbs, nothing seemed to help, and I spoke to the
baby's doctor about immediate supplementation. One of these mothers used
an SNS, with the AIM comprising nearly the entire feed. Although we always
hoped that the baby would get more milk, even when she tried Goat's Rue
Weed (?) and continued to nurse him, she still produced very little milk. (The
other mother was so disappointed that she opted not to continue to try to
nurse.)
The mother who used the SNS was nursing her second baby. The first had
ended up dehydrated, and hospitalized, but we caught the second in time to
avoid hospitalization. Although she never made a large quantity of milk, she
used the SNS for several months, and enjoyed the experience, despite the
baby only obtaining dribs and drabs of her milk. We decided that the
experience and even small quantities of her milk WAS worth the effort. But,
she never grew any additional ductal tissue, and her supply never increased.
The mom you are working with also has the challenge of the possibility of any
residual ducts being severed by the surgery. Was her Nipple Moved during the
Reconstruction? If so, she may face even more steep challenges. However,
with a supplementer, it may still be something she wants to do.
With the mother I worked with her used the SNS, she ended up using the
widest tubing, and putting BOTH tubes taped to one breast at a time,
otherwise the feeding would often last for more than an hour. She did,
however, enjoy him at the breast, and felt it was worth the effort. However,
she never grew any new tissue, and her supply never seemed to increase.
Good luck,
Mary Jozwiak IBCLC, RLC, LLLL
Private Practice
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