Breastfeeding after breast surgery

A mother’s milk production capability post any breast surgery will fall somewhere on a continuum of full milk supply, partial milk supply, or no milk supply at all.  It is hard to determine what effect a past surgery will have on the production and/or supply of milk prior to the birth. 

Augmentation  ( Breast Implants ) 

A breast augmentation is a medical procedure which involves inserting saline or silicone implants on top or beneath the chest muscle. Breast implants can be used to:

  • Enlarge small breasts
  • Restore breast volume after weight reduction or pregnancy and breastfeeding
  • Even up asymmetric breasts
  • Reconstruct a breast after mastectomy or injury

Determining the effect breast implants may have on breastfeeding

  • The reason for breast augmentation. Women who have a breast augmentation due to lack of glandular tissue or hypoplasia (breast that appear tubular- shaped, widely spaced, undeveloped or asymmetrical) may have had reduced milk production capability prior to the surgical procedures.
  • The placement of the implant. Implants can be placed behind or in front of the chest muscle. Implants placed on top of the chest muscle increase the risk of reduced milk production due to pressure on the glandular tissue obstructing the flow.
  • How the surgery was performed. Severing ducts and nerves can result in lower milk production. The location and extent of the incision/s can determine how the milk supply is affected.
  • The incision or changes to the nipple’s position. Nerve responses from the nipple and areola area is situated in the lower outer quadrant of the breast. Any disruption of these can reduce the milk ejection response (let down) which will affect ability to breastfeed and consequently milk supply

Breast Reduction 

A breast reduction is a surgical procedure that reduces the size of overly large breasts by removing excess breast fat, glandular tissue and skin to achieve a breast size that is in proportion with the body. The procedure is usually designed to alleviate the discomfort associated with overly large breasts but can also be for aesthetic reasons. 

Breast reduction surgery is more likely to cause milk supply issues than a breast augmentation due to: 

  • Large amount of glandular tissue and fat being taken away (to reduce the size/volume of the breasts) which can interrupt nerves and ducts that are needed for milk production. Depending on time between surgery and pregnancy, glandular tissue can redevelop and nerves can regrow.
  • The nipple may need to be moved to higher position to suit the new breast shape. Depending on the technique, this can further damage nerves and ducts, which in turn can impact on ejection reflex and milk production. If a free nipple graft is performed, successful breastfeeding may be very unlikely. 

Mastectomy  

A mastectomy is the removal of the breast. It is usually a treatment for breast cancer. There are 5 types of mastectomies and one or both breasts can be removed depending on diagnosis. 

Women who have had a single mastectomy are usually able to breastfeed from the other breast and their supply will regulate to the needs of the baby. 

Tips

Seek information about what surgery/procedure was performed – Surgical technique can affect ability to breastfeed. This may help predict the likelihood of producing breast milk and will help breastfeeding professionals build a breastfeeding plan and set realistic exceptions and goals 

  • Consult with IBCLC during pregnancy
  • Set yourself up for a great start to breastfeeding :
  • Skin to skin contact for at least 2 hours post birth
    • Attempt early breastfeed (within 2 hours of birth) with infant led attachment 
    • Avoid top ups, bottles and dummies 
    • Feed on demand or express regularly ( if not direct feeding) to ensure adequate supply
    • Educate yourself on signs of normal and low supply 
  • If there is a supply issue,  consult with an IBCLC. Suggestions may include  assessment of latch and transfer of milk,  assessment of feeding routine , use of supplemental nursing system (SNS),  donor milk, pumping or power pumping  and maybe  discussing the use of herbal and prescription galactagogues with a trusted doctor. 
  • Women should remember that any amount of breastmilk and breastfeeding  is beneficial to both the mother and baby.  

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