Small breasts, no milk?

My sister has A cup sized breasts and that's why she didn't breastfeed in the first place. She had been told all her life: "Women with small breasts can't breastfeed. There's no way there's enough milk".

As you can guess, this statement belongs to the realm of old wives' tales.

Old wives' tales are untrue, made-up stories intended for an uninformed listener. Historically, the term dates back to the wet nurses of the 18th century. They told the children in their care unbelievable stories or fairy tales in order to entertain the little ones through thrill and to force them into obedience by frightening them.  

But now we have science.
The size of the breast does not correlate with the ability to breastfeed. How much milk the breast is capable of producing depends on mammary gland tissue and hormones. And, of course, it depends on getting off to a good start to breastfeeding and sensible management afterwards.

Only 1 - 4% of women have too little breast tissue and therefore too little milk. And these women can be easily recognised. They often suffer from PCOS (polycystic ovary syndrome). They may also have another condition that is associated with hormonal imbalances that make it impossible to breastfeed adequately. IBCLCs (certified lactation consultants) are trained to recognise this. The history and shape of the breast can give us a good prediction. Basically, if your breasts grow by about one cup size during pregnancy, then everything is usually as it should be.

So, small breasts do not mean that there is insufficient mammary gland tissue and large breasts do not mean the opposite. Breasts also consist of fat and connective tissue structures. These parts are variable from person to person.

A small breast can have significantly more glandular tissue than a larger one. And so it also depends on the storage capacity of the breast whether one or always two breasts have to be given for a breastfeeding session. The basic rule is: to start breastfeeding, both breasts should always be offered in the first one to two weeks to stimulate milk production well. After that, the baby's behaviour and the woman's storage capacity are decisive. Therefore, it is very individual whether one or two breasts are needed.

If two breasts are always given, even though the mother has quite a lot of milk, a child could also become malnourished. This happens when the baby too often receives the rather thirst-quenching, low-calorie milk that often starts a breastfeeding session. 

A breastfeeding meal, in contrast to a formula bottle meal, has a "chronology": first comes a fairly watery milk with minerals and lactose. This quenches the child's thirst and quickly brings the blood sugar up. As the meal progresses, the milk becomes richer and fattier. This is partly due to the fact that the fats are attached to the inner wall of the mammary gland cell in small globules. And the more this milk cell expresses itself, the more fat gets into the milk. So, when breastfeeding, the baby has a starter, a main course and a wonderful dessert. Amazing thing - isn't it?

The conclusion of the refutation of this old wives' tale is that the size of the breast says nothing about the ability to breastfeed.

And some good news at the end: even women with too little breast tissue can quite probably breastfeed fully with the right preparation. After all, with two breasts, nature has also prepared well for twins. 

If you have any questions about your personal breastfeeding ability and the basics of a good start to breastfeeding, ask your IBCLC breastfeeding and lactation consultant.

Here you can find more parts of our series "Old wives' tales about breastfeeding“:
Part 1 - We dispel old wives' tales

Coming soon:
Part 3 - Not enough milk for the first few days?
Part 4 - Formula is just as good as breast milk these days, isn't it?

This text was written by Eva Vogelgesang

DIDYMOS babywearing instructor trainer and IBCLC and EFNB-certified paediatric nurse