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All About Hypoplastic Breasts

Posted by on Mar. 4, 2009 at 10:47 PM
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  • Type 1 – Round breasts, normal in physical characteristics
  • Type 2 – Hypoplasia of lower medial quadrant
  • Type 3 - Hypoplasia of the lower medial and lateral quadrants
  • Type 4 - Severe constrictions, minimal breast base

History of awareness of insufficient glandular tissue

The first article related to lactation was published by by Maryann Neifert and Joy Seacat in Pediatrics 1985.  Although there had been much discussion of this condition in the plastic surgery literature, this was the first attention paid to the breastfeeding sequella.

In a landmark study, Huggins, Petok and Mireles developed a  classification system to help health care providers determine the extent of the deficiency.  The study,  Markers of Lactation Insufficiency, was published in Current Issues in Clinical Lactation in 2000.

Although it is only recently this condition has been reported in the medical literature, it has been known for centuries.  There are reports of ancient writings warning about women with "more than a hand's breath" between their breasts.

Typical characteristics

  • High mammary fold - the base of the breasts is higher than normal, usually at rib 5.
  • Narrow (flat) breast base - the breast is oval or flattened at the base where it attaches to the rib cage rather than round
  • Breast tissue cascades over mammary fold producing ptosis even in small breasts - breast tissue droops over the high mammary fold
  • Central herniation of breast tissue into the areola resulting in plump nipples
  • Patchy areas of milk producing tissue
  • Little or no prominent veining
  • Large areolas
  • Darkly pigmented areolas
  • Widely spaced breasts > 1.5’
  • Marked asymmetry
  • Stretch marks
  • Little or no growth during pregnancy
  • Little or no engorgement
  • Normal prolactin levels

Physiology : Estrogen mediates ductal growth and progesterone mediates alveolar growth

The process during adolescence that results in asymmetrical, underdeveloped breasts is unclear at this time.  One theory is that, at least in some girls, it would be linked to too little progesterone, since progesterone mediates the growth of alveoli.   During each menstrual cycle, proliferation and active growth of duct tissue occurs during the follicular and ovulatory phases, reaching maximum during the late luteal phase and then regressing.  During each ovulatory cycle peaks of progesterone foster further mammary development that never regresses to its former state of the preceding cycle.   Is it possible that low progesterone during breast development, the window between 12-17 years old, is responsible?   And why would progesterone be low in some girls?  

Trauma to breast tissue and radiation therapy can affect breast development.  However, most women who have insufficient glandular tissue report nothing unusual in their medical  history.

Prolactin receptors develop during pregnancy and early lactation.  If there is less breast tissue, then it would follow that less prolactin receptors would develop. All of these physiological speculations are questions yet to be confirmed.

Completion of the development of mammary function occurs during pregnancy.  Progesterone, prolactin or human placental lactogen are thought to be necessary for the final stages of mammary growth and differentiation.  Since progesterone is high during pregnancy, that might result in additional breast development.  Some women note mild breast changes during pregnancy, others report none.

The link between insufficient glandular tissue and plycystic ovary syndrome are unclear at this time.  PCOS is an imbalance between insulin, progesterone and estrogen that occurs in about 5-10 % women.  Symptoms can include excess hair growth, obesity, infrequent or absent menses, insulin resistance, and difficulty achieving and maintaining pregnancies. Some women with PCOS breastfeed normally, some have an over supply, and some have undersupply.  But many have some of same breast characteristics as women with insufficient glandular tissue

View additional information and become familiar with the appearance of tuberous (tubular)  breasts:

by on Mar. 4, 2009 at 10:47 PM
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by Group Owner on Mar. 4, 2009 at 10:48 PM

Tubular hypoplastic breast

There is one exception to the rule about breast size/shape and breastfeeding ability, and that is that few women have insufficient glandular tissue in their breasts. In other words they simply don't have enough milk producing cells, and these women can then experience milk supply problems. This condition is called breast hypoplasia or hypoplastic breasts.

This kind of breast is underdeveloped (hypoplastic) in terms of the milk glands. They lack normal fullness and may look like 'empty sacks', and may seem bulbous or swollen at the tip.  Many times hypoplastic breasts are widely spaced from each other, and narrow at the chest wall. Due to lack of glandular tissue, they have an elongated or tubular form, and often are quite small. The areola can be enlarged. There may be a significant asymmetry.  The breasts don't grow during pregnancy and there is no engorgement when the milk is supposed to come in after giving birth.

Scientists don't yet know for sure the reason(s) for this underdevelopment. One theory is that at least in some women it would be linked to too little progesterone, since progesterone mediates the growth of alveoli (milk making glands).

In a 2006 study in Mexico, teenage girls who lived in the agricultural valley with heavy pesticide use had poor mammary gland developmend, and 18.5% of them had NO milk glands.

Other issues include PCOS and other insulin metabolism issues, hypothyroidism, and testosterone overload. Fixing the metabolic issues may help, as might pushing lots of stimulation to increase prolactin levels after birth.

by Group Owner on Mar. 4, 2009 at 10:50 PM


Hypoplastic (underdeveloped) breasts

The potential problem

While most women's breasts become engorged within three days of delivery, hypoplastic breasts stay soft, so you may worry that your milk hasn't come in.

Hypoplastic breasts are very narrow, lack normal fullness, and may seem bulbous or swollen at the areola. They're likely to be widely spaced, and one breast may be substantially larger than the other. Hypoplastic breasts don't grow during pregnancy.

Can I breastfeed?

Possibly. Breasts of this kind may have fewer milk glands than normal, leading to milk-production problems during nursing.

Breast augmentation surgery can improve the appearance of underdeveloped breasts but can't solve the underlying milk supply problem.


Ask your lactation consultant or healthcare provider to assess your condition and give you tips on boosting milk production. You won't know how much milk you can produce until you start to nurse.

Breastfeeding expert and BabyCenter advisor Kathleen Huggins recommends the following approach:

•  Start nursing right after birth

•  Around three days after birth, start pumping with a fully automated pump to stimulate your milk production.

•  Consider taking herbs such as fenugreek to boost your milk supply.

"About 40 percent of women with hypoplastic breasts will get to full milk production by following these recommendations," says Huggins.

Have a lactation consultant or your baby's doctor weigh your child when he's 3 days old to make sure he hasn't lost more than 10 percent of his birth weight.

If you're able to produce only a portion of the milk your baby needs, you might consider using a supplementary device like the Medela Supplemental Nursing System (SNS) to boost your baby's milk intake. The Medela device consists of a plastic pouch to hold breast milk or formula and attached thin, flexible tubes that run down each breast to the nipple. Since your baby takes both nipple and tube into his mouth when he suckles, he benefits from all the breast milk that's available. Another popular device is the Lact-Aid Nursing Trainer. It works like the Medela system but has soft, collapsible plastic bags instead of plastic bottles to hold the formula, making it possible to nurse your baby more discreetly. These supplementers have two functions: They ensure that your baby is getting enough food and they encourage nipple sucking, which triggers more breast milk production.

If you're thinking about getting implants to change the appearance of your breasts but want to nurse your baby, postpone surgery until after you've given birth and nursed your last child.


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