Episode Summary:
In this episode of The IBCLC Mentor Podcast, Margaret Salty interviews Dr. Katrina Mitchell, a breast surgeon and breastfeeding medicine physician, about the complexities of low milk supply, tubular breasts, and why the term “insufficient glandular tissue” (IGT) may not be the best descriptor. They explore the anatomical and physiological factors that impact milk production and discuss how IBCLCs can best support families in these situations.
Dr. Mitchell’s Background and Journey into Breastfeeding Medicine
Dr. Mitchell shares her unique path into breastfeeding medicine, including:
- Her work as a breast surgeon and lactation-focused physician in Santa Barbara, California
- Her early exposure to breastfeeding in her family and her time living in Tanzania, where she developed a passion for public health and women's health
- How her personal breastfeeding journey shaped her clinical approach to lactation support
Why We Should Stop Using “Insufficient Glandular Tissue” (IGT)
Dr. Mitchell explains why she dislikes the term IGT and why it is misleading. Topics include:
- The problematic use of “insufficient” and how it differs from standard medical terminology
- The importance of using correct anatomical descriptions, such as tubular breast and hypogalactia
- How IGT lacks specificity and does not explain the underlying causes of low milk production
Understanding Tubular Breasts and Their Impact on Lactation
Dr. Mitchell provides a deep dive into tubular breasts, a condition that affects breast morphology and may contribute to low milk supply:
- How tubular breasts develop due to a congenital issue during in-utero development
- The key visual characteristics of tubular breasts, including:
- Asymmetry (one breast significantly larger than the other)
- Large areolas relative to the breast base
- A narrow breast base and short distance between the nipple and the inframammary fold
- Why tubular breasts should not be confused with small breasts that produce adequate milk
Challenges in Diagnosing Tubular Breasts and Low Milk Supply
Margaret and Dr. Mitchell discuss why many cases of tubular breasts go unrecognized, including:
- The lack of provider education on breast anatomy beyond cancer screening
- The misconception that breast size determines milk production
- Why palpation of the breast does not reliably indicate glandular tissue volume or function
Supporting Parents with Low Milk Supply
Dr. Mitchell emphasizes how IBCLCs can best support parents experiencing low supply due to tubular breasts or other factors:
- The importance of setting realistic expectations and avoiding unnecessary stress
- Why the focus should be on optimizing milk supply rather than forcing "triple feeding" routines
- How to approach supplementation in a way that preserves the breastfeeding relationship
- Strategies for using galactagogues, including Reglan (metoclopramide) trials to assess responsiveness
The Role of Hormones and Breast Growth in Subsequent Pregnancies
Margaret and Dr. Mitchell discuss common questions about hormonal influences and whether breast tissue can develop more with each pregnancy:
- Why there is currently no conclusive evidence that tubular breasts respond to hormonal stimulation
- Observational trends that suggest milk production often improves in subsequent pregnancies
- The need for more research into the hormonal and structural changes of the breast over time
What We Still Don’t Know: The Gaps in Lactation Science
Dr. Mitchell...
