In my large practice with 4-6 thousand visits to the clinic per year, I also see 3 or 4 moms with insuff. glandular development of the breasts (IGDB) per year. Niefert described a long tube like breast but I have seen many types including women only partly affected by this phenom. These moms are usually aware that there is something different about their breast(s). It is important to assure mother that it isn't something she's done but the problem occured when she was a devolping fetus. Sometimes the size and shape of the breast makes IGDB obvious in other cases a little detective work is needed. Simple tentitive diagnosis involves a breast exam with the mom lying flat. The lactating tissue should feel like a circular mound. There can be areas where the breast is well developed and areas where a wedge of tissue is missing. The most common areas affected are the upper and/ or lower quads nearest the breast bone. Confirmation of the diagnosis is by an ultra sound of the lactating breast. One case we had was a mom with size DD breasts that showed no substantial lactating tissue inside the breast on ultra sound. She had a small amount under the areola so a few drops could be expressed. In cases where a wedge is missing the remainder of the lactating tissue seems to provide well for the baby. Of interest is something we've seen in HELLP syndrome where the mother has a severe postpartum bleed. In one case, the mother's blood loss resulted in what the physicians called a *pitutary infarct.* She never made milk. Since that case we have instituted a policy of following the nursing couple for several weeks if mom's Hgb went below 7 post partum. We've found that they may take up to ten days or more to get their *milk in.* It's like mom's body has to get its act together before it is heality enough to lactate. So we encourage patience and use a feeding tube in the mean time. We use the smallest possible tube so the baby doesn't develop a lazy suckle. We have a lot of elderly (40-45) primigravida's who have a great deal of difficulty with establishing a milk supply. Often they are in vitro or GIFT clients. One of our physicians has a theory about the low supply and pitutary function. He believes that the pitutary may just be old and not capable of producing sufficient amounts of prolactin. Anybody else seen this? What do you think?