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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.
- 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: