When you just can't make enough milk - the truth about hypoplasia/IGT.

Updated: a day ago

by Alissa Pemberton Midwife, International Board Certified Lactation Consultant (IBCLC), Infant Massage Instructor and Gentle Sleep Coach

*Please note this article contains images of real human breasts in various stages of hypoplasia

For the majority of women, exclusive breastfeeding is completely possible. Some mums may feel they couldn't breastfeed because of a variety of issues, but the majority of these can - with access to the right support - be solved. There is however, a small percentage of the population (about 1%) have a condition called breast hypoplasia or IGT (insufficient glandular tissue) which limits their milk production and means they may not be able to exclusively breastfeed their baby. In general, breast size doesn't have a direct impact on how much milk we can make. Small breasts don't necessarily produce less milk than larger breasts - what determines our milk making capacity is the amount of functional tissue in our breasts. This is our milk making tissue. We all have a certain amount of it, but during pregnancy the lactocytes (milk making cells) are 'primed' over the course of the pregnancy from about 16-18 weeks. These cells begin producing colostrum, and eventually will produce mature milk. Mums with less functional tissue to begin with, have less potential for milk making as even in the best circumstances there are physically less lactocytes to be 'primed' or 'switched on'. Breast size variations between women are usually due to differences in the amount of fatty tissue, so a mum with A cup breasts may be able to produce a full milk supply with her baby, just as a mum with DD cup breasts will - it's not the size that matters but the amount of functional tissue within the breast. Low milk supply can be: Pre Glandular - this includes hormonal issues like retained placental tissue, poorly managed over/under active thyroid, polycystic ovarian syndrome (PCOS) etc. Post Glandular - this includes anything that happens after your baby is born, such as ineffective milk removal, infrequent feeding, scheduled feeds, mum and baby being separated, early formula substitution etc. Glandular - this encompasses issues caused by previous breast surgery as well as insufficient glandular tissue (IGT/Hypoplasia) Why does IGT occur? Women may have insufficient glandular tissue if either there has been a lack of development during puberty, or due to surgery such as breast reduction. How will you know if you've got IGT? There are a number of warning signs to look out for which may indicate IGT. Depending on the case there may be obvious visual signs or within a mums history which suggest to clinicians that IGT may be causing issues with milk supply, sometimes it can be a process of elimination to diagnose. Some signs to look out for:

- lack of breast development during puberty (A) - widely spaced breasts (more than 4cm in between breasts over the sternum (A,B,F) - asymmetrical breasts (one side being noticeably smaller/larger than the other) (E) - tubular breasts (breasts which are narrow and long, often with a large areola, but lacking roundness/fullness) (C/D) - very large or bulbous areolae (they may appear as if they're almost separate to the breast, or much larger/wider than the majority of the breast). (C) - absence or breast size changes during pregnancy or postnatally.

Note: having some of these signs doesn't mean you definitely have IGT or that you won't be able to produce a full milk supply, but it indicates there may be issues and it's worth seeking the assessment of a breastfeeding professional such as an IBCLC (click here to find your local IBCLC in the UK)