When breasts become nursing breasts

In Denmark, approximately 99% of pregnant women want to breastfeed their child. And this means that almost all expectant mothers have considerations and thoughts about their upcoming breastfeeding process. There are many circumstances that affect how and how well a breastfeeding process will work. And since breastfeeding is a collaboration between mother and baby, some of the circumstances will have to do with the child and others with the mother.

For example, in the case of a child, it matters how much the child weighs at birth, whether he/she was born on time (or prematurely), whether the birth was uncomplicated or perhaps long and involved interventions, whether the sucking technique is good and the tongue tie is not too tight.

And for the new mother, it may be important how any previous breastfeeding experiences have been, how the birth has progressed, including any interventions and medications, stress, hormonal imbalances, and conditions surrounding the breasts such as size, shape, inverted or flat nipples, breast surgeries, piercings, etc.

Many mothers-to-be therefore also have concerns about whether and how well their breasts will function as nursing breasts when the time comes. But although these concerns are completely understandable and can also be relevant, they are fortunately often unnecessary, as the vast majority of breasts are naturally excellent for breastfeeding. So let's take a closer look at what happens to breasts when they become nursing breasts and what individual factors can affect breastfeeding.

The breast develops already during pregnancy

Breasts come in many sizes, and the main filling of the breast is fatty tissue and mammary gland tissue. The ratio of fatty tissue to glandular tissue in non-breastfeeding women is approximately 1:1, whereas after giving birth it will be approximately 1:2, i.e. twice as much glandular tissue as fatty tissue. Also running inside the tissue are the milk ducts, which function as transport routes for the milk and end at the nipple as ducts.

It is in the glandular tissue that milk production itself takes place, not in the fatty tissue. And therefore it does not have much significance what size the breast is before pregnancy and birth, because a great deal of development of the glandular tissue occurs during pregnancy and immediately after birth. For the same reason, many pregnant women also experience that their breasts grow in size already during pregnancy. And at least in the days after birth.

The breasts already start to produce colostrum about halfway through pregnancy. Some pregnant women experience being able to express a little colostrum, or see it as a small spot in their bra right from that point. While others only experience it later and some not at all until after birth. Regardless, the colostrum is in the breast.

Difference between small and large breasts

Breast size and milk production

Both small and large (and in between) breasts are designed to produce breast milk in sufficient quantities to fully nourish the newborn baby for the first 6 months. As described above, there is a great deal of development of the mammary gland tissue during pregnancy and after birth, which means that the vast majority of breasts are larger during this period than usual. And this means that small breasts are usually not so small anymore once breastfeeding is about to start – or has started. Small breasts can also contain plenty of mammary gland tissue.

The size of your breasts, as a rule, does not have much impact on whether you will be able to produce enough milk for your baby or not, with the exception of hypoplastic breasts, which you can read more about further down the page.

What is most important for establishing and maintaining milk production is that breastfeeding gets off to a good start. It is breastfeeding in the first few hours and days that helps to start milk production.

Therefore, it is of great importance that the first breastfeeding occurs early after birth, that the breasts are stimulated frequently (by breastfeeding or expressing), especially in the first few days but also afterwards, that the stimulation of the breasts is effective (i.e. that the child eats with a correct sucking technique and without using a nursing pad), and that there is peace around the establishment of breastfeeding.

Women with larger breasts seem to have a slightly larger storage capacity for milk than women with smaller breasts. Which in practice may mean that their babies have access to a slightly larger amount of milk per breastfeeding and may therefore choose to eat more milk at a time and then in turn with slightly longer intervals between. Just as it may also have an impact on whether your baby needs to eat one or both breasts during a breastfeeding. But this is not necessarily the case for everyone, as there are plenty of other factors that are more decisive for milk production than the size of the breast itself.

Breast size and breastfeeding in practice

The size and shape of the breasts, on the other hand, will often have an impact on breastfeeding in practice. There may be differences in which breastfeeding positions work best for different breasts. Just as there is also a difference in “handling” a large and soft breast compared to a small and firm one. Laid Back breastfeeding positions can be difficult to get to work well for women with large, soft breasts, whereas the twin position is often good here. If you have soft breasts, you may also need to help your baby keep the breast and nipple slightly in shape during breastfeeding, so that the nipple does not slip into the child's mouth.

The size and shape of your breasts can also have an impact on which nursing pillow works best for you, as well as how to best shape your nursing pillow to provide you and your baby with optimal support during many hours of breastfeeding every day. Just as there can be a difference in which type of nursing bra supports the breasts best.

The breasts when the milk comes in

When the milk comes in 2-4 days after birth, there is often a lot of milk. And also more than your little baby can eat. At this time, milk production has not yet adapted to the child's needs. This means that the breasts often become both large and very tense. Both because there is a lot of milk in them, but also because fluid accumulation occurs in the breast tissue during these days.

Some new mothers are shocked by how much happens to their breasts when their milk comes in. And it can also cause pain and discomfort when there is so much pressure. It is important to know that the breasts will not remain as large or as firm as they were during this phase. During the first 1-2 weeks after birth, milk production regulates itself according to the concept of “demand and supply”, where the breasts will produce the amount of milk that the baby actually consumes. The fluid accumulation will also decrease, and the breast will therefore feel softer again and not as large.

After the milk has come in, the breasts can still grow and become more tender the longer it has been since the baby last fed. However, they will become soft again after the next feeding. Many women experience more tender breasts at night and in the morning compared to other times of the day because milk production is highest there.

What if the breasts are different in size?

Many women have breasts that are not the same size. Some with a big difference, but most to a lesser extent. The fact that the breasts are not the same size does not have to have any significance. The glandular tissue develops in both, and therefore the smaller breast will also grow and have more mammary glandular tissue. The exception, however, is hypoplastic breasts, which you can read about further down the page.

I find that different sized breasts, even if there is enough milk overall, can be a challenge for some women with breastfeeding. Because the larger breast will often contain more milk than the smaller one and will also often have a faster flow of milk, it can create an expectation and preference in the child for how “it should be”.

This can cause the baby to be more impatient when he/she is breastfed on the “slow” breast. Because he/she is used to it going faster. Babies, like us adults, are designed to use the most energy where the greatest benefit is. This has nothing to do with laziness, but is in fact a completely natural survival mechanism. For the same reason, some babies are very quick to become happy with the bottle if they experience being full more and faster on it than at the breast.

In addition, it will often happen that the baby is breastfed the most on the largest/fastest breast, because there is milk here for a longer time. It can also happen that the baby, on the breast with the most milk, has enough in one breast to be full. But when he/she starts breastfeeding on the breast with the least milk, he/she is not full enough afterwards and therefore needs to be topped up on the other. This will mean that the breast that already produces the most milk will also be stimulated more than the other, whereby the difference can gradually become larger and larger, so that the breast with the most milk produces more and more - and the breast with the least milk produces less and less.

The challenge here is typically not that your child is not thriving and gaining weight well from breastfeeding. After all, milk is fine overall. But it can be frustrating and a source of many worries and considerations if you have a baby who is irritated and frustrated with one breast and / or who may end up rejecting it completely. Here it can be a really good idea to seek out tailored professional guidance from a breastfeeding counselor who can assess your situation and help you make the most optimal plan for breastfeeding in the future.

The nipples

Just as breasts come in many sizes and shapes, so do nipples. Some are large, some are small, some are very prominent, while others are flatter or even inverted. And the size of the dark area around the nipples (areola) can also vary.

Small or flat nipples

Many expectant mothers are concerned about small or flat nipples. Will this make breastfeeding difficult and make it difficult for their baby to latch on well? Here again, it is good to know that the nipples also undergo a major change during pregnancy and in the first days after birth due to hormonal influences. Both the dark area and the nipple become larger in diameter, and the dark area often also becomes more pigmented and thus darker in color.

It is important to remember that a newborn baby has never tried breastfeeding before and therefore has no preference for how a nipple should feel inside the mouth. The baby only gets that experience after birth and here the experience will arise based on the exact size and shape of the nipple that the individual woman has.

With many years of experience as a breastfeeding counselor, I would say that flat or small nipples are not more difficult to breastfeed with than nipples that are more prominent. But it is of course important to get off to a good start and to help your child latch on to the breast with a good technique, so that the nipple is well supported against the child's palate, where the sucking reflex is stimulated. If you have flat or small nipples, it may also be necessary to shape the breast more to the child than if the nipple is more prominent on its own. All women can learn this.

In addition, it can help to massage the nipple just before breastfeeding and thus make the nipple more visible and firm.

Inverted nipples

There can be a lot of confusion surrounding inverted nipples. What exactly is an inverted nipple? And what does it mean for breastfeeding?

Approximately 3% of all women have inverted nipples, and in 87% of them, it is only on one nipple. Of all women with inverted nipples, only 4% are “true” inverted, meaning they cannot be helped forward. With truly inverted nipples, it can be difficult for the baby to latch on to the nipple, and it can also be difficult to stimulate the nipple sufficiently to create a good milk transfer to the baby. Fortunately, as the numbers show, this is a very rare condition, and when it is present, it will usually only be on one breast.

If you have truly inverted nipples, it may be beneficial to seek advice about your upcoming breastfeeding journey even before you give birth. This way, you know exactly what you can do to help your breastfeeding as best as possible from the start in your specific situation.

Inverted nipples, which can be helped out (not truly inverted), will often become less inverted during the breastfeeding process and also less from breastfeeding to breastfeeding. In addition, they will take on a different shape inside the baby's mouth during breastfeeding than they do between breastfeedings, as the baby's stimulation causes the nipple to double in length during breastfeeding.

It may be helpful to manually express the nipple just before the baby is latched on, either with your fingers or with a breast pump. A nipple shaper worn inside the bra between feeds may also be beneficial for some women.

Nipple piercing

Nipple piercings can sometimes damage the breast tissue, affecting breastfeeding. Fortunately, this does not happen to everyone. If you have a piercing, it is a good idea to remove it when you become pregnant so that it does not interfere with the development of your breasts during pregnancy. And of course, you should not breastfeed with a nipple piercing, as in the worst case scenario it can come loose and pose a risk of suffocation to your child.

The challenges that nipple piercings can present are related to the scar tissue and potentially altered structures that may be present in the ducts where the milk is supposed to flow out. This may mean that the milk flows differently to the baby on the breast that is pierced (if only one) compared to the other.

Scar tissue can block some of the ducts or cause a smaller passage, which can cause the milk to flow more slowly and thus also make it more difficult for the baby to empty the breast effectively. This leads to an increased risk of clogged milk ducts and mastitis. There may also be a flow of milk from the piercing holes, which can make it harder for the baby to maintain a vacuum and also cause him/her to choke on the milk more easily.

If nerve damage has occurred that has led to reduced or complete loss of sensation in the nipple after a piercing, this can also affect breastfeeding. It is stimulation of the nipple that triggers the secretion of oxytocin, which causes the let-down reflex. And in women with lack of or reduced sensation in the nipple, there may therefore be difficulties in creating a sufficient flow of milk from the breast, because the let-down reflex cannot be triggered.

Breast surgeries

All types of breast surgery can present challenges for breastfeeding – but they don't necessarily. Breast surgery is therefore, in principle, not an obstacle to starting breastfeeding, but it can be an advantage to be aware in advance of the challenges you may experience and seek help to be on the cutting edge. It is also important to pay special attention to ensuring that breastfeeding works and that your baby is in good health.

Breast augmentation surgeries

Breast augmentation surgery involves placing an implant in the breast behind the breast tissue. Although the implant is not inside the breast tissue, it can still affect milk production, both because the constant pressure from the implant can damage the glandular tissue, but also because it takes up space and can prevent the glandular tissue from filling up with milk as much as it otherwise would. This can cause challenges with having enough milk both in the short term and in the long term, when the baby's need for milk increases.

If you have problems with too little milk, a solution may be to breastfeed more frequently, because that way you can give your baby more milk overall throughout the day.

Statistically, the chance of full breastfeeding is approximately 40% less for women with breast augmentation surgery compared to women who have not had surgery.

Breast reduction

Breast reduction surgery involves surgery on the breast tissue itself, which can cause damage and scar tissue to glandular tissue, nerves, and milk ducts. The chances of achieving successful breastfeeding depend greatly on the surgical technique used and how much glandular tissue is removed.

The breastfeeding challenges that can arise after a breast reduction are most often related to milk production, which can be difficult to establish and maintain, as well as to emptying the breast if the milk ducts and milk ducts are damaged.

Regardless of the type of breast surgery, it is particularly important to pay attention to whether breastfeeding is proceeding as expected, that milk is flowing, and that baby is thriving and not losing too much weight or gaining too little. It is (as always) important that mother and baby have uninterrupted skin-to-skin contact after birth, if possible, and that the first breastfeeding occurs early after birth. In addition, frequent stimulation/breastfeeding of the breasts in the first few days is of great importance for establishing milk production.

Hypoplastic breasts

Hypoplastic breasts are breasts that are underdeveloped and therefore contain only a small amount of glandular tissue. This is a rare condition, but it can make it difficult or even impossible to produce enough milk to fully breastfeed.

Hypoplastic breasts often have a characteristic appearance with an elongated shape (tube shape / banana shape), a large dark area (areola), a large gap between the breasts and often also asymmetry with different size / shape of the breasts.

It is impossible to know in advance how much your breasts will develop during pregnancy and in the days after birth, so it is always worth starting breastfeeding, even if you suspect that your breasts are hypoplastic. But it is also important to pay extra attention to the development of your breasts, the flow of milk, the well-being of your baby and not losing too much weight / gaining too little.

It can be a really good idea to seek help with your breastfeeding even before you give birth, so that you have a clear plan for what you can do to identify any challenges and get ahead of them.

This article is written by midwife and breastfeeding counselor Camilla Kristiansen, BabyAkademiet.