Insufficient breast tissue, a false diagnosis?

A case study

A mother and her 3 month old baby presented at the International Breastfeeding Centre in Toronto because of late onset sore nipples. I noted that the baby had a tongue tie, previously undiagnosed, which was one reason that caused the baby not to latch on well. Late onset sore nipples is usually due to late onset decreased milk supply.

There were several reasons why this mother would have had a decrease in her milk supply.

The mother, based solely on the appearance of her breasts (see photo 1), was diagnosed immediately after the birth as having “insufficient glandular tissue”. Based on this diagnosis, the baby was immediately, at his very first feeding, supplemented with formula with a lactation aid at the breast.

Is it IGT?

Photo 1: This mother was diagnosed as IGT simply on the basis of the appearance of the breasts. In spite of this false diagnosis, she went on to breastfeed exclusively by the time the baby was 6 weeks of age. The diagnosis of Insufficient glandular tissue should not be made only on the basis of the appearance of the breast.

The shape of the breast does not always determine milk production

Photo 2 : This mother, a different mother than in photo 1, was diagnosed as having insufficient glandular tissue, partly based on the shape and size of her breasts. In spite of the diagnosis, with support, she was able to breastfeed exclusively.

The baby was on a bottle for the first 6 weeks of his life. The baby was also using a nipple shield starting at 2 weeks of age and was on it for 20 days.

When we saw the baby at 3 months of age, the mother, on her own, had managed to get the baby off the bottles (except for 1 or 2 small bottles of expressed milk a week), and off the nipple shield. Thus, when she and the baby presented at the clinic, the baby was exclusively breastfed and had been so for 6 weeks. The baby was growing well and drinking well at the breast despite the initial “diagnosis” of insufficient glandular tissue.

We released the tongue tie, only one of the causes of her late onset sore nipples.

Insufficient glandular tissue is a diagnosis that should be avoided. For several reasons:

  1. It is a “diagnosis” which essentially tells the mother that there is no hope she will ever breastfeed exclusively.
  2. As these two cases show, nobody can look at a woman’s breasts and nipples and predict her ability to breastfeed exclusively. In fact, we have had other such cases where the diagnosis of insufficient glandular tissue had been made and the mothers were able to breastfeed exclusively.
  3. As in the case discussed, the baby was supplemented immediately after birth, based simply on the appearance of the mother’s nipples and breasts (see photo) even though, later on she was able to breastfeed exclusively. Given that, why would she not be able to breastfeed exclusively from birth?
  4. Because of this false diagnosis, many interventions were imposed on this mother and baby pair, which resulted in unnecessary supplementation, use a nipple shield (how does a nipple shield help with “insufficient milk supply”, but despite these unnecessary interventions, the mother eventually managed to breastfeed exclusively.
  5. Instead of looking at the at the size and shape of the breast, health providers should be watching the baby at the breast, because it is quite possible to know if the baby is drinking well at the breast, or not, or something in between. See videos below.
  6. New mothers are set up for failure when they receive such a “diagnosis”. They may decide that breastfeeding is not going to work and may not persist in getting good hands on help.


Here is our approach when the baby may not be getting enough from the breast:

  1. Get the best latch possible. A baby with a tongue tie, by definition, does not have a good latch,
  2. Know how to know the baby is getting milk from the breast or not: Click these links Really good drinking with English text, Twelve day old nibbling, English Text, “Borderline” drinking for video clips showing babies drinking well at the breast, or not.  Watch the videos, read the texts and then watch the videos again.
  3. Use breast compressions to increase the milk intake of your baby: . Breast compression is like pumping but instead of pumping into a container, you pump directly into the baby. Pumping is hard work and very often discouraging for the mother if she gets only very small amounts.
  4. When the baby is falling asleep at the breast and not drinking, switch sides and go back to point 1.
  5. When the baby is not drinking on the second side, you may have to supplement, but supplement with a lactation aid at the breast. For this device to work, the baby needs a good latch and the tube needs to be well placed. Even if you need to supplement, if you use this device, you are still breastfeeding.
  6. Domperidone can increase your milk supply. Read carefully: domperidone. We start with a dose of 30 mg (3 tablets) three times a day and often go up from there.
  7. The bottle is a problem. Even if you must supplement, it is better to supplement with a lactation aid at the breast.  Breastfeeding is more than breastmilk. Keeping the baby at the breast also helps increase the milk supply even if you are supplementing.

Need help with breastfeeding?  Make an appointment at our clinic.

Copyright: Dr Jack Newman, MD, FRCPC, Andrea Polokova, 2019, 2021