Anatomical breast variability has been a subject of focus in The Breastfeeding Atlas since the first edition was published in 1999. Kay Hoover and I have observed clinically that flat, inverted, or large nipples and large breasts create significant challenges to breastfeeding. We have extensively photographed and described these four anatomical breast variations, and have long advocated for clinical research to examine the effects of anatomic variability on breastfeeding outcomes.
The paper by Vazirineja, et al (see abstract below) validates our observations that some breast and nipple variations negatively affect early infant weight gain. Previous research has documented that flat nipples and inverted nipples impact on breastfeeding. The new research identifies a negative effect of large nipples and large breasts upon infant weight. The difference in the average weights at 7 days was significant; 215 g (about half a pound) between the “normal” and the variations group.
It would have been helpful for the researchers to specifically describe breast and nipple sizes and to quantify what they meant by “large nipple” and “large breast.” Providing normative ranges and accurate size measurements will help clinicians identify women and infants in risk categories.
We hope these important research findings prompt earlier interventions to prevent infant weight loss. We advocate for individual assessment and active management of lactation when breast or nipple variations are observed. Appropriate interventions might include close weight monitoring, use of nipple shields, “insurance” pumping, and alternative feeding of the infant with pumped milk to prevent infant weight loss. Creative positioning strategies, effective parental counseling, and tincture of time also support optimal breastfeeding outcomes and help prevent untimely weaning.
The article abstract appears below. A full text of the article is available at:
The effect of maternal breast variations on neonatal weight gain in the first seven days of life
Reza Vazirinejad, Shokoofeh Darakhshan, Abbas Esmaeili
International Breastfeeding Journal 2009, 4:13doi:10.1186/1746-4358-4-13
This study aims to examine whether specific maternal breast variations (such as flat nipple, inverted nipple, large breast or/and large nipple) are barriers for weight gain in breastfed infants during the first seven days of life.
In this prospective cohort study, 100 healthy term neonates were followed from birth to day seven in two groups; Group A: fifty neonates born to mothers with specified breast variations and Group B: fifty neonates born to mothers without such breast variations (“normal breasts”). All neonates were the first child of their families and there was no sex ratio difference between the two groups. Neonates’ weight at birth and day seven were measured and the mean weight differences in the two groups were compared using paired t-test.
Neonates born to mothers without the specified breast variations had a mean weight gain of (+) 53 ± 154.4 g at day seven., Not only there was no increase in the mean weight of neonates in the other group, but they had a mean decrease of weight of (-) 162 ± 125.5 g by the seventh day of their life compared to birth weight. Thus, neonates born to mothers without breast variations had significantly greater weight gain than neonates born to the mothers with the specified variations (p < 0.01).
Breast variation among first-time mothers acts as an important barrier to weight gain among breastfed neonates in the early days of life. Health professionals need skills in the management of breastfeeding among mothers with the specified breast variations, so that mothers are given appropriate advice on how to breastfeed and overcome these problems.
For students and clinicians interested in reviewing the literature on the subject of breast and nipple anatomy, we suggest the following
Caglar MK, Ozer I, Altugan FS. Risk factors for excess weight loss and hypernatremia in exclusively breastfed infants. Brazilian Journal of Medical and Biological Research 2006; 39:539-544.
Cooper W, Atherton H, Kahana M, Kotagal U. Increased incidence of severe breastfeeding malnutrition and hypernatremia in a metropolitan area. Pediatrics 1995; 96(5):957-960.
Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 2003; 112(3):607-619.
Livingstone VH, Willis CE, Abdel-Wareth LO, Thiessen P, Lockitch G. Neonatal hypernatremic dehydration associated with breastfeeding malnutrition: a retrospective survey. Canadian Medical Assoc J 2000; 162(5):647-652.
Ramsay D, Kent J, Hartmann R, et al. Anatomy of the lactating human breast defined with ultrasound imagine. J Anatomy 2005; 206(6):525-534.
Wilson-Clay B, Maloney BM. A reporting tool to facilitate community-based follow-up for at-risk breastfeeding dyads at hospital discharge. Current Issues in Clinical Lactation, 59-67, 2002.
Yaseen H, Salem M, Darwich M. Clinical presentation of hypernatremic dehydration in exclusively breastfed neonates. Indian J Pediatr 2004; 71(12):1059-1062.