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Breast Feeding

Breast reduction and breastfeeding...

11/30/1999

Question:

Are there any instances in which a woman who has had a reduction mammaplasty breast feed? Does the physican have to have kept all lines of ducts properly connected in order for them to heal into breasts able to produce milk? Are there any documented cases that have shown a patient of a reduction mammaplasty having the breast tissue heal itself enough to produce milk? If no, can surgery restore the ability to produce breast milk or would too much tissue generally have been destoryed in the initial reduction mammaplasty? Also, do pregnant women that have had reduction mammaplastys experience any physical discomfort due to breast tissue swelling as a result of being engorged with milk they can`t expell or should enough of the milk ducts have been removed during surgery to prevent such a side affect? I have heard that the La Leche league offers a program by where a mother can provide the milk of nursing mothers to there own child...if this is true, under what conditions must this take place? Is there a means of provding ones child with breast milk if unable to produce your own?

Answer:

Many women with reduction mammoplasty have breastfed. Some can fully breastfeed; others must partially breastfeed and also use some amount of supplement--how much depends on the situation. The individual woman and the extent, or type, of reduction surgery she has had determine which she is able to do. Before reduction mammoplasty, a surgeon should explain the possible effects the surgery could have on lactation/breastfeeding so the woman can take that into consideration. If a surgeon is aware that a woman wants to optimize her ability to breastfeed in the future, it may be possible to do a procedure that leaves more gland (milk-producing) tissue in addition to keeping the nipple and areola attached to that gland tissue via a "pedicle" technique.

Breastfeeding usually is possible even if some ducts were cut during the surgery. To fully breastfeed, however, there must be enough gland tissue still connected to open ducts so that enough milk can be made and then transported to the baby during breastfeeding. Fortunately, most breasts are capable of producing a lot more milk than they are "asked" to produce for a single baby, so many women are able to produce quite a bit of milk as long as a reasonable amount of gland tissue and attached ducts are available.

However, if many milk ducts were cut, or an important nerve was cut, or a lot of glandular tissue was removed during surgery, lactation--the ability to produce milk--is going to be affected to some degree. Usually a new mother must "wait and see" to discover just how much breastfeeding is affected. Often a woman doesn`t know if enough gland and duct tissue remain until she`s breastfed her new baby for several days to a week.

It is very important that a woman be honest and let the baby`s pediatric care provider, the postpartum nurses and the IBCLC (International Board Certified Lactation Consultant) know if she`s had a reduction mammoplasty. Then health care providers can then watch her more carefully during breastfeeding for signs that the baby is "removing" milk from her breasts and they can watch the baby for signs that she/he is getting enough breast milk. If it becomes obvious that full breastfeeeding is not possible, a mother may supplement during breastfeedings by using a feeding tube system taped to the breast. An IBCLC or other breastfeeding support leader would be able to help a mother with this. (I would suggest consulting with an IBCLC or a very knowledgeable and experienced breastfeeding support leader, such as a La Leche League leader before a baby`s birth.)

It is possible for milk to become "trapped" in areas of gland tissue if this tissue is behind ducts that have been cut and so the area cannot "drain" during breastfeeding. In this situation, uncomfortable but localized engorgement can temporarily result. The use of ice/cold packs applied to those areas between breastfeedings or pumping sessions usually helps. Engorgement generally does not remain a problem, as the milk-producing cells in those areas soon "dry up" if ducts are not available to transport milk to the nipple. This does not affect the milk-producing cells in gland tissue that do have ducts available to transport milk to the nipple; those areas can keep producing milk just fine.

There are human milk banks in different parts of the USA and other countries, but La Leche League does not maintain a human milk bank at either the local or international levels. (They do have excellent information related to breastfeeding after mammoplasty reduction surgery, however.) Different milk banks have different "rules" as to which babies are given priority for available milk, but usually babies receive it based on medical necessity. Authorized human milk banks screen potential donors. Donors freeze their milk for delivery to a milk bank where it is thawed, cultured, and pasteurized. For more information, contact the Human Milk Banking Association of North America , Inc. (HMBANA); Phone: 560-888-4041, 888-232-8809 (toll free within the US); Fax 508-888-8050, E-mail: milkbank@capecod.net or their web site below.

All the best.

References:

Lawrence, RA & Lawrence, RM (1999) Breastfeeding: A guide for the medical profession (5th ed.). St. Louis, MO: Mosby.

Riordan, J & Auerbach, KG (1999). Breastfeeding and human lactation (2nd ed.). Sudbury, MA: Jones & Bartlett.

Related Resources:

Milk Banks

For more information:

Go to the Breast Feeding health topic, where you can:

Response by:

Karen Kerkhoff Gromada, MSN, RN, IBCLC
Adjunct Clinical Instructor
College of Nursing
University of Cincinnati