Does Breast Size Affect Breastfeeding? Understanding Breast Anatomy and Milk Supply

Many mothers worry about their breastfeeding capability because of uneven size or shape of their breasts. But can breast anatomy really affect breastfeeding?

Let's understand breast anatomy and how mammary glands work to find out what truly affects breast milk production.

Breast Anatomy: How Breasts Make Milk

1. Alveoli are tiny sacs arranged like a bunch of grapes in your breast. They make and store milk.
2. Each breast has around 15-20 milk ducts or lactiferous ducts carrying this milk from alveoli to the areola.
3. Areola is the dark skin around your nipple – this is where the baby needs to latch to get milk.
4. Fat and tissue fill most of the breast – they give size and shape to your breasts. They do not make milk.

Most mothers with unequal size or shape of breasts have normal numbers of alveoli – they can breastfeed successfully. Even mothers with fewer alveoli can breastfeed with some help.

Breast Changes In Pregnancy: Are My Breasts Ready To Make Milk?

Hormones released during pregnancy prepare your breasts for breastfeeding by making new alveoli and milk ducts. If you can feel these changes during pregnancy, it is a good sign that your breasts are getting ready to make milk:

• Breasts grow and feel heavy
• Stretch marks and veins can be seen on the skin
• Areola becomes larger and darker
• Tiny bumps appear on areola – Montgomery glands (make oils that keep the nipple soft and healthy)
• Nipples become more prominent
• Some yellowish milk (colostrum) may leak from breasts

After birth, prolactin hormone helps make milk continuously, while oxytocin hormone causes milk let-down during feeding - it squeezes the alveoli to push milk out to the baby.

Should I Worry If I Do Not Feel Breast Changes?

Every pregnancy is different. Some mothers feel these changes early in pregnancy while others feel them late. But eventually, almost all mothers will have breast changes.

tip

Consult your doctor if you have small breasts, tube-shaped breasts, breast scars from surgery or injury, and do not feel breast changes during pregnancy.

Does Having Small Breasts Affect Milk Supply?

Fat and tissue fill most of the breast. Mothers with small breasts have less fat, but usually have a good number of alveoli. So, most mothers with small breasts can make enough milk for their babies.

However, in rare cases, small breasts may be underdeveloped due to insufficient glandular tissue. Here are some signs to watch for:

How To Identify Underdeveloped Breasts?

Some mothers with small breasts may have underdeveloped breasts (also called tubular or hypoplastic breasts), which may have fewer alveoli. Research by Huggins et al. (2000) found several signs that may help identify underdeveloped breasts:

• Widely spaced breasts – flat gap between breasts more than 4 centimeters
• Unequal breasts – one breast is much larger than the other
• Tubular breast shape – cone shape
• Very large or bulging areola
• Stretch marks on breasts without breast growth during puberty or pregnancy
• No breast changes in pregnancy or after delivery (such as darkening of nipple and areola, breast growth, more visible veins, or tenderness)

Mothers with underdeveloped breasts can still breastfeed, but may need extra help such as galactagogues (milk-increasing medicines), or supplemental feeding systems (lactation aids). It is important to talk to a lactation counselor early for help and support.

How To Breastfeed With Unequal Breasts

Some mothers have unequal breasts even before pregnancy, and it is normal. Breasts may become unequal if you feed more often from one breast, because your body makes more milk in the breast that is used more. Unequal breasts do not affect milk supply, and breasts usually return to their original size when you stop breastfeeding.

Tips to balance unequal breasts:

• Feed from the smaller breast first, and then switch to the larger breast. After breastfeeding, stimulate the smaller breast with a breast pump for extra 5 minutes.
• Feeding from the smaller breast first may leave your larger breast filled with milk. Pump out extra milk after each feeding to keep your breast healthy.
• If you have pain while feeding from one breast, talk to a lactation counselor to check latch and position.
• Talk to your baby's doctor if you worry about your milk supply. The doctor will check baby's weight gain and milk intake.

Know that some difference in size of breasts is normal while breastfeeding. If you and your baby can breastfeed comfortably, all is well!

Can I Breastfeed After Breast Surgery Or Injury?

Surgery or injury to the breasts can damage milk-producing alveoli, affecting milk supply. But serious damage to alveoli is rare. Most women can breastfeed with some help.

• Breast implants: Usually does not affect breastfeeding, especially if the cut was under the breast or in the armpit
• Breast reduction: May affect milk supply if ducts and nerves were cut, but many mothers can still breastfeed
• Breast biopsy or lumpectomy: Usually has little effect on breastfeeding
• Nipple piercing: Usually heals well, but many piercings may damage milk ducts

How To Breastfeed After Breast Surgery

• Watch for breast changes during pregnancy. This will show whether your breasts are preparing for milk production.
• Discuss your breast surgery with your doctor and lactation counselor before delivery. They will help assess your need for lactation support.
• Have your baby's feeding assessed after birth. A pediatrician or lactation counselor will check if your baby is getting enough milk and gaining weight properly.
• If needed, your doctor or lactation counselor may recommend galactagogue (milk-increasing medicines or herbs) to boost milk supply.
• If your milk supply remains low, your baby's doctor may suggest a Supplemental Nursing System (SNS) – also called Lactation Aid. This device lets you continue breastfeeding while supplementing your baby with extra milk through a thin tube.

How Can I Breastfeed With Very Large Breasts?

Mothers with large breasts may find it challenging to position and latch the baby at first, but they can successfully breastfeed with the right methods. Here's what you can do:

• Sit comfortably upright with good back support.
• Use pillows to bring baby up to breast level – this stops you from bending over.
• Support your baby with one hand and hold your breast with another hand in a 'C' shape (thumb on top, fingers below) to help the baby latch over areola.
• Once latched, check for signs of good attachment – baby's mouth wide open, lower lip turned out, chin touching your breast, most of the areola inside baby's mouth.
• Wear a well-fitted cotton bra that supports your breasts. The bra should not be too tight.
• Get help from a lactation counselor early to find comfortable breastfeeding positions.
• Have your baby's weight gain checked by your baby's doctor.

Summary

• Every mother's breasts are different, and most can breastfeed successfully regardless of breast size or shape.
• Start breastfeeding within 1 hour of baby's birth to initiate the hormonal changes leading to ample milk production.
• If you have concerns about your breasts or milk supply, get help early from a lactation counselor or your doctor.

Feel free to contact us for any questions or suggestions. We would love to hear from you.

Tips to get a good breastfeeding latch.

Learn how to express breast milk effectively.

Further Reading

1. About Breastfeeding and Breast Milk
2. Infant and young child feeding (WHO)
3. Breastfeeding and the Use of Human Milk

References

1. Huggins KE, Petok ES, Mireles O. Markers of lactation insufficiency: a study of 34 mothers. Current Issues in Clinical Lactation 2000;25–35.