StorkNet interview with
Anne Smith, IBCLC
International Board Certified Lactation Consultant

Be sure to visit Anne Smith's website for more breastfeeding information and wonderful products. Also, read her articles on StorkNet.

Q's and A's:

BREASTFEEDING AFTER BREAST REDUCTION

Jennifer: Is there any early way to tell if a woman will definitely be able to breastfeed? I had a breast reduction three years ago, and although I seem to have slight sensation around my breasts, the nipple/areola area has always been more sensitive then before my operation. Curious if that is a good sign? I'm hoping to breastfeed! Thank you for any advice or guidance in advance :) Jennifer

Anne: I have worked with many women who have had breast reduction surgery over the years, and have seen outcomes ranging from no milk production at all to full production. The only way you will know for sure how your body will respond is to try breastfeeding and see what happens.

The outcome depends on many variables. Some milk ducts are almost always cut during a breast reduction, but if a surgeon makes a deliberate effort to leave the blood supply and nerve pathways intact, it is certainly better than if he removes tissue without regard for these concerns. I would like to think that most doctors who are doing reduction surgery on young women of childbearing age would try to preserve these structures, but that is not always the case.

Another variable is how much tissue was taken out during the procedure. The more glandular tissue that is removed, the less the chances are of producing a full milk supply.

Another factor to consider is whether the nipples were completely removed and repositioned (the free-nipple technique, most often used for women with extremely large breasts) or whether the pedicle technique was used (the nipple stays attached to the breast gland on a strip of tissue, which means the ducts, blood supply, and some nerves remain intact, making successful breastfeeding more likely). The free-nipple technique involves completely severing the blood supply to the nipple and areola, and some degree of nerve damage invariably occurs. Complete breastfeeding without supplements is rarely possible if the free-nipple technique is used.

If milk ducts were cut during the surgery, you may produce a full supply of milk, but not be able to pass it all through the damaged ducts. The more ducts that have been damaged or severed, the less milk the baby will receive. There have been some reports of mother's milk ducts growing back (this is called "recanalizing") although this is unusual.

Usually, if major nerves were cut during surgery, you would have little or no sensation in your nipple and areola, which can decrease milk production because the baby's sucking stimulates nerve endings which send the pituitary gland the signals to produce and let-down the milk. The fact that you still have sensation in your nipples is very encouraging, but you still won't know how breastfeeding will go until you try.

You may experience more engorgement than a mother who hasn't had surgery, because the milk may back up in the damaged ducts and lead to swelling. Within a few days, the milk will be reabsorbed in those areas and you will be comfortable again.

You will need to monitor the baby's urine and stool output and weight gain carefully to see if a supplement is needed. It certainly makes sense to breastfeed your baby, because almost all mothers will produce some milk after reduction surgery, and you can still have a nurturing breastfeeding experience even if your baby gets some breastmilk and some formula. Some mothers who haven't had breast surgery don't produce a full milk supply and have to supplement, and some choose the option of combining both from day one. Any breastmilk at all is good for your baby, and you can still experience all the bonding and closeness of nursing your baby regardless of the amount of milk that you produce.

The best advice I have for you is to try to contact your surgeon to get more details about the type of surgery that was performed so that you know what you are dealing with. Educate yourself about breastfeeding in general, just as you would if you hadn't had the surgery. Be aware that you may not produce a full supply, but plan to enjoy nursing your baby while making sure that he/she gets enough milk one way or the other.

The main Breastfeeding after a Reduction (BFAR) website:
http://www.bfar.org

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