Trouble Breastfeeding? Insufficient Glandular Tissue May Be to Blame

While it is not a condition that many prospective parents may have heard of, insufficient glandular tissue (IGT), also known as mammary hypoplasia, can have a significant impact on breastfeeding. The condition is not easy to diagnose prior to giving birth, so women may not know they have it until they begin breastfeeding.

An IGT diagnosis means you have fewer glands and ducts that are able to produce milk inside the breasts. The condition is caused by the lack of development of glandular tissue—tissue that produces milk—in the breast during pregnancy, according to Jamie Chia Lin, M.D., a Los Angeles-based OB-GYN.

Lin explained that this condition can be caused by several factors, including genetic makeup, disorders of the endocrine system or a lack of the hormone prolactin, which stimulates milk production after childbirth. Surgeries such as breast enhancements can sometimes disrupt breast tissue and increase the risk of IGT, she added.

Diagnosing IGT before pregnancy

While diagnosing IGT before birth is uncommon, there are some ways to look for physical signs of insufficient tissue in the breasts, said Constance M. Chen, M.D., a board-certified plastic surgeon and breast reconstruction specialist in New York City.

One indicator can be a large space that is more than 4 centimeters between breasts. Other signs include breast asymmetry, narrow tubular breasts, very large and bulbous areolae, and lack of breast changes in pregnancy or after childbirth, Chen said. But she stressed that these symptoms don't inherently mean a person can't produce a full milk supply.

It's important to note that smaller breasts are not an indicator of IGT, said Chrisie Rosenthal, an International Board Certified Lactation Consultant (IBCLC) in Los Angeles and consultant relations manager with the Lactation Network. This is a common misconception she comes across, but she wants parents to know that breast size is not a determinant. She advised getting a clinical diagnosis if your breasts show signs of IGT or you are unable to produce a full milk supply even with appropriate interventions from a professional.

How to fix insufficient glandular tissue

Unfortunately, there is no definitive solution to IGT even after it is diagnosed. There isn't a reliable way to increase the glandular tissue needed for greater volumes of milk production, Chen said. She doesn't recommend excess milk pumping as it can be "ineffective and disheartening," she said. It can also lead to mastitis—an infection of the breast tissue—if you experience trauma or damage to the nipples.

Supplementation is one option, Chen advised.

"Women who have IGT can still breastfeed, but they may need to supplement with formula," she said.

However, the caveat is that a nursing parent must have some glandular tissue present to make milk.

Lin suggested that parents see their healthcare provider and ask about taking prolactin or some form of galactagogue to increase milk production. Parents can also enlist the help of a milk bank.

"Early intervention and working closely with an IBCLC is key," Rosenthal advised.

She recommended letting your consultant know what your feeding goals are in order to help achieve them. In her role, she has seen a wide range of experiences, from combination feeding to exclusive pumping to supplemental nursing systems, in which babies feed at the breast with additional milk in a tube to keep them in place and augment a low milk supply.

Take care of your mental health

Feeding a newborn baby can be very taxing on the body and mind, and difficulties can put parents at risk of postnatal depression. This is why it's vital to openly talk about and acknowledge the feelings that may arise during this time, especially if exclusive breastfeeding was a goal.

"It's important to mourn the breastfeeding relationship that you thought you would have, and if you're working with an IBCLC, they will help you identify those parts that may be retained," Rosenthal said.

Aside from breastfeeding, there are many other ways you can bond with your baby and help them feel calm and nurtured: massage, skin-to-skin contact (also known as kangaroo care), bathing, talking and singing.

While breastfeeding problems can weigh heavily on your mind, a solution is very much about finding what works for you and your baby with the support of healthcare professionals. Despite any stress or worry an IGT diagnosis can cause, just remember, a fed child is best.