Low Milk Supply
True primary low supply (insufficient glandular tissue or hormonal dysfunction) is rare — estimated at 2–5% of lactating people. More commonly, apparent low supply results from suboptimal breastfeeding management: inadequate feeding frequency, poor latch reducing milk transfer efficiency, or early supplementation reducing suckling stimulus (and thus prolactin). Supply operates on a supply-demand loop — the more milk removed, the more is produced. Identifying whether low supply is primary or secondary requires assessment by a lactation consultant or physician.
Engorgement
Engorgement occurs when milk production is established but removal is insufficient. The breast fills with milk and oedema accumulates in surrounding tissue, creating painful hardness that can paradoxically make feeding more difficult (a swollen areola is harder for an infant to latch on to). Treatment is frequent feeding or pumping to remove milk, and reverse pressure softening of the areola before feeding. Engorgement typically resolves as supply calibrates to demand within days to weeks.
Mastitis
Mastitis is inflammation of breast tissue, often infectious. It presents as a red, hot, painful area of the breast with flu-like systemic symptoms. It typically results from milk stasis combined with bacterial entry through a cracked nipple. Staphylococcus aureus is the most common causative organism. Treatment includes continued breastfeeding from the affected breast (clearing the blocked area), antibiotics, and analgesics. Untreated mastitis can progress to abscess formation requiring drainage.
Breastfeeding After Augmentation
People with breast implants face additional considerations: periareolar incisions carry higher risk of partial ductal disruption. Subglandular placement can compress glandular tissue. Many augmented people breastfeed successfully; some experience reduced milk supply or difficulties latching due to changes in breast shape or nipple position. Working with a lactation consultant from early in the postpartum period is particularly valuable for augmented patients.
