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By Christine Klynhans

Midwife and Breastfeeding Counsellor

In their own eyes, very few women have perfect breasts, which is not surprising considering how magazines, movies and television bombard then with images of how their breasts should look. It is a real pity that we’ve come to use these images as the standard against which we measure the real thing, as many of these breasts are the outcome of lots of money spent on plastic surgery, combined with artful airbrushing and other techniques to create a goal most will never reach.

These insecurities are perhaps most pronounced when women have babies and start breastfeeding. In Western culture breasts are seen as sexual objects, there for the pleasure of partners. Producing milk and feeding a baby does not fit in with this image, which is why most people feel uncomfortable with mothers breastfeeding in public.

Because they already see their breasts as not perfect, women are often scared that their breasts and nipples may not be the correct shape and size to feed their babies. The good news is that, with breastfeeding (almost) anything goes! While certain qualities in your breasts and nipples may create breastfeeding challenges, most women will still be able to successfully feed their babies. We take a closer look.

Small breasts

Women with small breasts are often concerned that they won’t be able to produce enough milk to feed their babies. The good news is that breast size has nothing to do with milk production. The only possible difference lies in breastmilk storage capacity. This refers to the amount of milk that the breast can store at a time. Breastmilk storage capacity tends to be smaller in women with smaller breasts, and their babies may need to feed a bit more frequently. The amount of milk that the breast can produce is not less. It’s important to know that this is normal, as many mothers interpret frequent feeding as a sign that they are not able to produce enough milk.

Large, pendulous breasts

Pendulous breasts are breasts that do not have an upright and/or round appearance, and are instead longer and more cylindrically shaped. This shape is very common amongst women with large breasts.

Large breasts are just as able to breastfeed as any other, but they do present mothers with a few challenges. Luckily these can be overcome (Smith 2013):

  • Take trouble to find a nursing bra that really fits, which can be difficult. It should not be too tight, and you should avoid underwired bras, as these can stem milk flow, causing breast lumps and mastitis.
  • Experiment with different feeding positions. Many women with bigger breasts find that the football hold works better for them, as they have better control over baby’s head.
  • Be sure to support the breast while nursing, which may also be difficult as the traditional ‘c-hold’ may not work that well. Some mothers find that rolling up a washcloth and placing this under the breast can provide the support that’s needed.
  • You may need help with latching, especially if you also have large nipples and areolas. Your midwife should be able to assist or can refer you to a lactation consultant.
  • Gently massage your breasts while nursing to help ensure that your milk ducts are being emptied adequately.
  • Experiment with lying down on your side and breastfeeding – many large-breasted women find this easier. As an added bonus you get the chance to rest while feeding!
  • Large breasted women are more likely to have skin irritations and infections due to the folds of skin underneath their breasts. Candida infections and heat rashes are both also more likely in moist areas. Wash your breasts daily with water and dry them thoroughly, paying special attention to the area under the breast. You can even use a hair dryer to assist with this.
  • If you plan to use a breast pump you would need one with larger flanges.

Exceptionally long nipples

Although longer and larger nipples mostly make feeding easier, in ‘severe’ cases it can lead to baby gagging when sucking, and thus struggling to latch. Remember though that this is the exception, not the rule.

Make sure that your baby is opening his mouth as big as possible before putting in the nipple. You should also experiment with different positions to help you find the one most comfortable. Occasionally this may stay a challenge until baby has grown a bit, and his/her mouth is bigger.

Inverted nipples

Inverted nipples retract rather than protrude when baby latches on to the breast. Slight inversions may not affect breastfeeding, but if it is severe baby may struggle to latch. There is controversy on whether women should be screened in pregnancy already for inverted nipples and if treatment to pull the nipples out should begin. Many feel that it will simply damage a mom’s self-confidence.

There is not enough research supporting the different techniques for pulling out the nipples in pregnancy already. Apart from this, due to change in tissue elasticity, by the time that baby is born nipple inversion is often no longer a problem. A mother who had a previous bad breastfeeding experience because of an inversion may well benefit from pregnancy treatment.

Remember that most babies do struggle a bit with latching initially, whether mom has inverted nipples or not. It’s important to just be patient and persist.

If you have inverted nipples the following tips may prove helpful:

  • Use a breastpump or other suction device before a feed to help pull the nipple out.
  • Stimulate your nipples before a feed – roll them between your fingers, or apply a cold cloth.
  • Wear breast shells for 30 minutes before a feed.
  • Express some milk and use a dropper or syringe to apply to your nipple while baby is trying to latch. This will encourage him to continue even though he may struggle. You can also give him a small sip to swallow from a syringe or cup, as swallowing is often accompanied by better latching.
  • When latching on, try pulling back lightly on the breast tissue to help the nipple protrude.
  • If all else fails you can use a nipple shield. Be sure that it is a good fit for mom and baby. A nipple shield is not the ultimate solution. Many babies who do not latch well onto the breasts may also not latch well onto a shield. A shield lessens the stimulation on your nipples during feedings, which may influence your milk supply. If this is the case, consider expressing with a breast pump for 10 minutes on a side after a feed, simply to increase your supply.
  • Because the adhesions are stretched when baby sucks on the nipple and because the nipple may retract between feeds (leaving it moist), mothers with inverted nipples are more prone to sore nipples. Be sure to let your nipple dry completely before closing up. Apply a lanolin nipple ointment after every feed.

Breast augmentation (enlargement)

The effect of breast enlargement surgery on breastfeeding will depend on which technique/incision was used, and on whether (and how many) milk ducts were damaged. If your incisions are under the armpit or in the fold under the breast, your chances of feeding is better than if they are around your areola, in which case milk ducts and nerves were very likely damaged (Mohrbacher and Stock 2002). Although initial milk production is often not affected after augmentation, the woman’s body may not be able to keep up with baby’s rising demand.

Apart from damage to structures, any surgery causes scarring inside the breast, which can lead to discomfort when mom feeds and which can cause pressure on the milk producing glands, reducing supply. The pressure of implants on breast tissue can contribute to engorgement. There may also be milk glands that are unable to drain because their ducts have been severed. These may initially become engorged, but usually stops producing milk after a while.

While all of the above may sound discouraging, it is still possible to breastfeed after a breast enlargement, and only time will tell if you will experience any of the above problems. You would need to give special attention to dealing with engorgement and preventing mastitis, and to maintaining milk supply. Baby’s amount of wet and/or dirty nappies (and after a few weeks his weight gain) should be monitored to help ensure that he gets enough milk. If your breasts are unable to keep up with baby’s demand, there are many other alternatives to consider before simply stopping breastfeeding. Chat to your midwife or consider seeing a lactation consultant.

Breast reduction

A mother’s ability to produce enough milk after a breast reduction will fully depend on how much breast tissue was removed, and on whether her nipple was completely removed and repositioned. It once again is a case of wait and see. If milk ducts were severed you may have engorged areas in the breast that do not soften while feeding. Once again, after a few days these areas will stop producing milk (Mohrbacher and Stock 2002).

You will need to give special attention to milk supply, and it will be worthwhile to ask your doctor to prescribe medication to increase your milk supply. Your baby’s nappies and weight gain should be monitored to confirm that he’s getting enough milk. Once again, should you not be able to produce enough milk there are various alternatives that will enable you to at least partially continue breastfeeding (Mohrbacher and Stock 2002).

Bibliography:

Mohrbacher, N, Stock, J, 2002. La Leche League International – The Breastfeeding Answer Book. United States of America: La Leche League International.

Smith, A. 2013. Nursing Tips for the Large Breasted Woman [Online]. BreastfeedingBasics.com. Available at: http://www.breastfeedingbasics.com/articles/nursing-tips-for-the-large-breasted-woman [viewed 17 June 2014].

Riordan, J. and Wambach, K. 2010. Breastfeeding and Human Lactation. 4th ed. United States of America: Jones and Bartlett.