Small breasts can breastfeed just as well as big ones

It is the amount of fatty tissue that makes some breasts bigger than others. In other words, the milk producing apparatus is about the same in both small and big breasts. Therefore breast size is not linked to the ability to produce breast milk and breastfeed per se. Even flat-chested women, who don't have practically any fat cells in their breasts, can breastfeed. Besides, you really don't know your final breast size until after your first pregnancy, because the milk-producing cells and milk ducts grow and branch out a lot during the third trimester.

However, breast size does affect the breastfeeding relationship in at least two different ways. First of all, many times the babies of large breasted women have some difficulty in latching on in the beginning because they have such a tiny mouth in comparison to the areola they are supposed to take into their mouth and suck on. This problem usually goes away as the baby grows older. A lactation consultant can help with the initial problems; for example, the mother can pump the milk during the early weeks while the baby is learning a proper latch, and the pumped milk can be fed to the baby in a bottle.

Secondarily, the research of Peter Hartmann has shown that the milk storage capacity varies a lot between women. Breast milk is produced continually and it accumulates in the milk ducts between feedings. During feeding, a baby typically empties about 70-80% of the milk in the breast. Hartmann found in his studies that some women had 3 times as big a storage capacity than others - but that all of them produced the same amount of milk over a 24-hour period. In general, bigger breasts of course would have a bigger storage but it was noted that breast size was not always a good predictor of production or storage capacity.

In practical terms it means that women with small storage capacity breasts need to nurse more often, and the babies take in less per feeding. Women whose breasts have a larger storage capacity can 'deliver' more milk in one feeding, and so the baby needs to nurse fewer times per day. This further confirms the need of cue feeding or demand feeding where the baby sets the frequency of breastfeeding - and not the clock or the pediatrician or the grandmother.

Breast size in pregnancy, breastfeeding, and weaning

During pregnancy, breasts of course grow a lot in size. This is due to the milk-making system growth and development. Fat actually goes away from breasts at this time.

The 'peak' size is probably when the mature milk comes in about 3-5 days after delivery, because often there is some engorgement with that.

Then during breastfeeding, breasts will constantly change size a little bit, as the baby empties the breast, and they keep constantly making more milk w

At weaning, when the milk is no longer needed, the milk glands gradually atrophy or shrivel up. The breast will shrink in size.

Then, over a period of few months (or up to 6 months), fat is deposited back to the breast, and often the breast becomes about the same size as before pregnancy.

However, this doesn't happen to all women. In some women (it's a minority), their breasts do permamently stay looking like they do when the milk glands shrivel up at weaning - kind of emptyish bags.

With partial weaning, the breast size will go down some as well, since less milk is needed.

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.

There is also one interesting case reproted in the medical literature where a woman with such underdeveloped breasts was able to successfully nurse her second child, after being given natural progesterone during her second pregnancy. Progesterone stimulates the growth of the glandular tissue in breasts during pregnancy.

If you happen to have these tubular hypoplastic (under-developed) breasts, talk to a lactation consultant before giving birth. Even better, talk to a doctor before pregnancy about a possible natural progesterone treatment. There are measures you can take to try increase your milk supply and your chances of breastfeeding, such as

have an unmedicated birth if possible, and put the baby to the breast right after birth
nurse often and on cue
start to pump about three days after birth
try the herbs fenugreek and blessed thistle or the drug domperidone
breast compression technique to stimulate more letdowns
Correct underlying metabolic or hormonal issues (PCOS, hypothyroidism). One lady has posted her success story below; she was able to see breast changes during her 2nd pregnancy and subsequently breastfeed, after taking Metformin to correct her PCOS.

Discuss these and other options with the lactation consultant. You may need to supplement with formula,so it is important to observe the baby's output of wet and dirty diapers and weight gain to make sure the baby is getting enough nutrition. Remember also to be happy for whatever breast milk you produce and not blame yourself - even a little is better than none! And if you don't get any milk at all (which does happen), remember it's not your fault. For this kind of situation we are thankful that the baby formula exists.

Plastic surgeons try to take the most out of women with hypoplastic breasts. Since it is a true medical condition, they try to push these women to get implants to correct the deformity. Having hypoplastic breasts is not any dangerous condition. They look different, and as explained above, women with hypoplastic/tubular breasts often have difficulties in producing enough milk.

It is understandable to feel bad when you have deformed breasts, and there's nothing wrong if you wish to have it corrected. Unfortunately the implants will only lessen the milk supply and the probability of successful breastfeeding, besides forcing the woman to go through several surgeries throughout her lifetime, and putting her to a high risk of serious complications and diseases.

Sources and resources

Breastfeeding and underdeveloped (Hypoplastic) breasts from BabyCenter.com

Insufficient glandular tissue at Mothering.com Discussion Forums

MOBI - Mothers Overcoming Breastfeeding Issues
MOBI, a community of mothers and breastfeeding specialists, tries to provide women with compassion and understanding, whether their issues involve concrete breastfeeding questions, or emotional issues, such as helplessness, anger, and grief. The medical or emotional issues discussed at MOBI are not intended as a substitute for consultation from your health-care provider.

Insufficient Glandular Tissue - a good lesson.

Lactation failure due to insufficient glandular development of the breast Pediatrics. 1985 Nov;76(5):823-8.

Patient with insufficient glandular tissue experiences milk supply increase attributed to progesterone treatment for luteal phase defect. J Hum Lact. 1999 Dec;15(4):339-43.
In this one case, the woman was able to produce enough milk for her second child when she was treated with natural progesterone during that particular pregnancy. Progesterone stimulates the growth of the glandular tissue in breast (alveoli) during pregnancy.

A link between polycystic ovarian syndrome (PCOS) and insufficient milk supply - from Breastfeeding.com's nwesletter.

PCOS and Breastfeeding - an interview with Lesa Childers, talking about PCOS, low milk supply, and hypoplastic breasts.

Altered breast development in young girls from an agricultural environment. Environ Health Perspect. 2006 Mar;114(3):471-5.
"We examined the onset of breast development in a group of peripubertal girls from the Yaqui Valley of Sonora, Mexico. We observed that girls from valley towns, areas using modern agricultural practices, exhibited larger breast fields than those of girls living in the foothills... Further, girls from valley towns displayed a poorly defined relationship between breast size and mammary gland development, whereas girls from the Yaqui foothills, where traditional ranching occurs, show a robust positive relationship between breast size and mammary size. ... Mammary tissue, determined by palpation, was absent in 18.5% of the girls living in agricultural areas, although palpable breast adipose tissue was present."

All these breasts have succesfully nursed a baby/babies:

lactating

These are tubular breasts on an obese woman. They used to be A-cup before she gained a lot of weight.

"My breasts never changed during pregnancy or engorged after and with the help of a lactation consultant and a hospital grade pump we learned that I made no milk."

These small breasts appear hypoplastic, not having enough milk glands (glandular tissue), so there MAY be problems with milk supply.
tubular breasts

But you can't judge by appearance alone! The proof is in the pudding: the true test of having insufficient GLANDULAR tissue (not enough milk-making tissue) is to check if the breasts make enough milk after giving birth.

"I think breastfeeding is wonderful!"

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Does breast size affect
breastfeeding?

Small breasts can breastfeed just as well as big ones

Breast size in pregnancy, breastfeeding, and weaning

Tubular hypoplastic breast

Sources and resources

Other people's comments

THE BOOK!

Does breast size affectbreastfeeding?

Small breasts can breastfeed just as well as big ones

Breast size in pregnancy, breastfeeding, and weaning

Tubular hypoplastic breast

Sources and resources

Other people's comments

THE BOOK!

Does breast size affect
breastfeeding?