Monday, 9 June 2014

All Breasts Can Breastfeed

Stories of breastfeeding failure are demoralizing on a viral scale. One of the most common excuses mothers give for quitting breastfeeding is the assertion that their breasts malfunctioned. This gives other women a shaky perception of what their bodies are actually capable of. In this post I explain how and why the myth of widespread malfunctioning mammaries is utter tosh.

Pierced nipples: 

These chicks don’t usually cause a problem with breastfeeding. Occasionally, nipple piercings cause some of the milk ducts to seal over, so milk can’t get out from those sections of the breast. If this happens, milk production will stop in those areas and the rest of the breast will produce more (La Leche League 1999). You should remove any rings or bars before you feed, though, so they don’t hurt your baby’s mouth, or you may prefer to let the holes close and have your nipples re-pierced later.


Implants are inserted behind the milk-making tissue, so they don’t interfere with milk production or with the baby getting milk out (La Leche League 2013). Some women who have had implants find that their breasts are a bit tight, making them uncomfortable very quickly if feeding is delayed. You can prevent this by encouraging your baby to feed frequently and by hand-expressing your milk whenever he has a longer gap.

Breast Surgery: 

Whether breast surgery may affect breastfeeding depends on the reason for the operation and the way it was carried out. Surgery to remove a breast lump usually causes damage to the ducts, but only in one area of the breast. The rest of the breast (and the other breast, of course) will work normally. After a mastectomy it’s usually possible to fully breastfeed from the remaining breast (Rapley and Murkett 2012). I know personally of a mother who successfully breastfed after surgery to remove a breast tumour. Click here to read her story.

Breast Reduction: 

Breast reduction usually relies on removal of fat tissue (rather than milk-making tissue) but sometimes it involves cutting the milk ducts and the nerves that supply the nipple. If your nipples have been re-sited – and especially if they are no longer sensitive – breastfeeding may be difficult. Surgery to alter the shape of the nipples can have the same effect. However, breastfeeding can work after surgery and even if you can’t breastfeed your baby fully, he may be able to have some of your milk (Witte et al 2004La Leche League 2002).

Inverted Nipples: 

There are different degrees of nipple inversion. Some nipples are only slightly inverted, and a baby with a normal suck will bring out the nipple with no difficulty. Other nipples are moderately or severely inverted, which means that when compressed they retract deeply, to a level even with or behind the surrounding areola. But here’s an interesting and comforting fact: most nipples that are inverted in pregnancy will correct themselves by the time of delivery (See: ‘Timeline of Breast Changes in Pregnancy’). For those that don’t, good positioning and latch are normally sufficient to enable successful milk withdrawl. Remember, babies don't nipple-feed, they breastfeed. If baby is able to get a decent mouthful of breast, most types of inverted nipple will not cause a problem. A good latch means that baby’s mouth and gums will pypass the nipple entirely and latch on to the areola for effective breastfeeding. Other techniques, such as using breast shells and nipple shields, have not been proven in controlled studies to be effective (La Leche League 2003). If you do decide to use a nipple shield, try to remove it within the first few minutes of the feeding. Click here  to read an inverted nipples success story.

Flat Nipples: 

Like inverted nipples, a true flat nipple is one that cannot be compressed outward when stimulated or compressed. Also like inverted nipples, correct positioning will normally facilitate breastfeeding. Use of a breast pump or other suction device may help some women draw out flat or inverted nipples so that baby can latch onto the breast more easily (Click here to read about one mom’s success with flat nipples).

Large Breasts: 

Some large-breasted women have difficulty putting their babies to the breast because when they are sitting their breasts almost engulf their lap. If this is you, try rolling up a diaper or baby blanket and put it under their breast for support, to lift it high enough so that baby can latch on more easily. This will also enable you to get a good view of the latching action. Additionally, you may find the football hold more versatile than other positions as it gives you more control over your baby’s head and other movements, as well as giving you a stellar view. Lying down is another good position as your breast may rest on the mattress making it easier and more comfortable for both baby and you.

Small Breasts: 

Even if a woman is flat as a pancake her breasts will be able to do the job they were intended for. It is a myth that women with big breasts will be ‘better’ at breastfeeding. They may have more fatty tissue inside their breasts, but fat does not have a function as far as breastfeeding is concerned. Anatomically speaking, all lactating breasts perform in the same way. In no way does outward appearance affect the production of milk or a mother’s ability to dispense it.

Breast Trauma: 

Breast injury resulting from a fall or from being struck may result in nerve damage or damaged milk ducts. If the nipples and areolas have been injured, the ability to breastfeed depends on how well milk can flow through them. If only one breast is affected, mom should be able to feed exclusively using the unaffected breast. She will still make plenty of milk. Click here to read one mom’s success story of breastfeeding after breast trauma.

Raynaud’s of the nipple: 

This condition occurs when a spasm of blood vessels prevents blood from getting to the nipple (see illustration), this is usually felt as a burning sensation. Also referred to as a vasospasm, the condition is often worsens in response to a drop in temperature. There is no reason why a mother with Raynaud’s cannot breastfeed. Keeping the breast warm and covering straight after feeds are useful strategies. If pain is still an issue, Dr Jack Newman recommends a two week course of Nifedipine, a safe drug used for hypertension.

Nipple eczema: 

There is no reason why a mother with nipple eczema cannot breastfeed. In fact, freshly expressed breastmilk applied to the area can help to moisturize your skin and promote healing.

Large Nipples: 

Long or very wide nipples can occasionally make latching difficult because they trick the baby into starting to suck before he’s scooped up enough of the breast. Click here to read one mother’s triumph with large nipples. If your baby is having a hard time trying to get a big enough mouthful because you have large nipples, you may be able to help him by gently pressing your thumb into your breast just above your baby’s nose to tilt the nipple up slightly as you offer it to him, then let it unfold in his mouth, helping him to draw it in deeply before he starts sucking. 


Hypoplasia is underdevelopment or incomplete development of breast tissue (famously known as ‘insufficient glandular tissue’). When it comes to breastfeeding scaremongering, hypoplasia reigns supreme - an apparent 'Get Out of Jail Free' card. However La Leche League 2009 maintain: "With medical and emotional support and accurate information, mothers with hypoplasia can breastfeed their babies". Notice the use of the word 'can', not 'maybe'. Interesting. So, what's going on here? Well, some studies have asserted that the proportion of glandular tissue and the number and size of ducts are not even related to milk production (Ramsey et al 2005). And indeed, not all women with hypoplasia have milk supply difficulties, some exclusively breastfeed without any supplementation at all (Bodley and Powers 1999). In other cases, milk supply may be ‘compromised’. I say ‘compromised’ in inverted commas because all it not lost. In unilateral hypoplasia, for instance, blood flow velocities of the Internal Mammary Artery and the Lateral Thoracic Artery have been shown to be reduced by half to two-thirds compared to the breast producing copious amounts of milk (Geddes et al 2012). This, of course, means that at least a third of the woman’s milk supply will be a-okay. When hypoplasia reduces some of a mother's supply, there are numerous medications and herbs that have proven efficacy in increasing breast milk production (Arbour and Kessler 2013Duran and Spatz 2011). And some breast milk is always better than no breast milk. Always. Whether or not a mother continues to breastfeed with the milk she does have is telling of her true intentions. Many women with genuine hypoplasia go on to successfully breastfeed their babies with supplementation, despite having a seemingly perfect excuse to quit altogether (Thorley 2005). Funny that.

So there you have it. The reality is that the size, shape and features of your breasts are not reasons to hit the quit button.

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