Heads up, this post may contain affiliate links and any sales made through such links will reward me a small commission – check my Disclosure Policy to learn more. As an Amazon Associate I earn from qualifying purchases.
BREASTFEEDING AFTER BREAST SURGERY
There are millions of women of childbearing age who have had a breast reduction, breast augmentation, and breast biopsies. All of these procedures can affect breastfeeding.
Breast surgery has the potential to affect milk supply and whether your baby can get out the milk that you make. These surgeries can also affect how much impact engorgement has on the milk-producing cells.
WHAT SURGEONS TELL WOMEN ABOUT BREAST SURGERY AND BREASTFEEDING
Some women have these surgeries at times when they are so far from having babies that whether or not it may impact breastfeeding is the furthest thing from their minds.
Surgeons don’t always provide information about how the procedure may affect breastfeeding. Surgeons are getting better at trying to preserve a woman’s ability to breastfeed.
Some plastic surgeons tell women that they probably won’t be able to breastfeed after some of the procedures. Other surgeons say to women that it won’t have any impact on breastfeeding.
Neither is entirely true.
Other women, usually other mothers, can be a source of information as well as misinformation too.
TYPES OF BREAST SURGERY
- Breast augmentation
- Breast reduction
- Breast lift
REASONS FOR BREAST SURGERY
- Very large breasts can cause back pain, neck pain, and hunched shoulders because of the weight
- The weight of the breasts can result in a woman’s bra straps creating shoulder grooves
- Large breasts can affect the type of exercise women with large breasts can comfortably participate in
- Cosmetic reasons
Breast Reduction Methods
There are two different ways to decrease the size of a woman’s breasts
- While liposuction removes only fat tissue, the glandular tissue can be damaged from liposuction since they can’t see the inside of the breast during the procedure
- It is not very effective for very large breasts in reducing breast size significantly
- Surgical methods can vary as to where the incision is made and therefore, what type of scar a woman will have
- Surgical methods also can vary regarding what they do with the nipple
Nipples After Breast Reduction and Breastfeeding
- Nipples are how the milk gets from the glands in the breast out of your body.
- If the nipple is completely removed and repositioned, this will sever ducts
- If the nipple is left attached, this will help preserve those connections
- There are variations on how that procedure is done and referred to as inferior or superior pedicle techniques
- Inferior pedicle techniques are believed to result in better breastfeeding outcomes
You can begin to see how complicated this can get and how there are so many factors that can affect breastfeeding after breast reduction. This explains why some women with reductions have full milk supplies and other women who have had reductions don’t produce any milk.
One of the first things I ask women who have had breast augmentation is why they had it done. I’m not just nosy.
While most women have implants so they will have larger breasts, there are some women who get implants because they have very abnormally shaped breasts or one breast is very small compared to the other. This can be a sign of insufficient glandular tissue, which means there just are not enough glands to produce milk.
Breasts like this are sometimes referred to as tubular-shaped.
How Do Breast Implants Affect Breastfeeding?
Some people mistakenly think that since no breast tissue is being removed, breast augmentation should not affect breastfeeding. This is not the case. Just as with breast reduction, breast augmentation has different procedures.
Breast Augmentation Incision Locations
- Under the breast, in the crease
- In the armpit
- Through an incision just above the belly button – I rarely work with women who have had this incision, so I am not sure how frequently this procedure is done
- Areolar edge – this is great for concealing the scar but can sever a lot of the ducts and is considered the method that can have the most significant impact on breastfeeding. It is called a periareolar incision
How Implant Size Can Affect Breastfeeding
Implants can range in size from 80 ml to 800 ml (Source).
Larger sizes can increase the impact of engorgement.
The pressure from the implant can mimic severe, unrelieved engorgement. This puts pressure on the milk-producing cells, which can damage those cells if it is prolonged.
Engorgement welling can decrease with the application of ice packs, the pressure from the implants will not.
HOW TO PREPARE FOR BREASTFEEDING AFTER BREAST SURGERY
As with most things related to breastfeeding, education can make a significant difference in how breast surgery can impact breastfeeding.
Some excellent books on breastfeeding after breast surgery are:
- Defining Your Own Success by Diana West
- Breastfeeding After Breast and Nipple Procedures by Diana West and Elliott Hirsch
TIPS FOR BREASTFEEDING AFTER BREAST SURGERY
It’s essential to have a plan for what you are going to do after your baby is born.
- Breastfeed early and often
- Start using a breastpump within 12 hours of giving birth
- Use a breast pump 4-8 times every 24 hours
- Continue pumping at this rate until your baby is thriving on your breastmilk alone
- Herbs or medications can increase milk production
TAKE A WAIT AND SEE APPROACH
With any breast surgery, you will not know what the impact it is going to have on your supply, until you have a supply.
I have had moms who had breast reductions who never saw a drop of milk. I have also had moms who had a full supply with their first baby.
With breast augmentation, most moms will see drops at a minimum. Many will have full milk supplies.
With both breast reduction and breast augmentation, most moms will fall somewhere in between.
Moms can do a lot to optimize milk production resulting in full supplies.
Seeing colostrum is encouraging, but not a guarantee that you will not have issues with your supply.
You have to wait and see what happens when your milk comes is. If a lot of your breast tissue has been removed, you may not experience a lot of fullness or engorgement.
If you have had a breast augmentation with an incision around your areola, you may get very engorged.
When your milk comes in, you have to see if it can get out. If a lot of the ducts have been severed, there is no way for the milk to get out.
Engorgement can be severe and eventually, the milk dries up.
Be vigilant with managing engorgement. Breastfeed frequently and apply ice packs for 15-20 minutes (never longer) every couple of hours.
When your baby breastfeeds, listen for a lot of swallowing. If you are pumping, look to see how much milk is spraying out. Pay attention to whether your breasts soften with feedings.
It’s best to work with a lactation consultant. Unfortunately you can’t just make a check list to figure out if everything is working the way it should.
ENCOURAGING SIGNS WHEN BREASTFEEDING AFTER BREAST SURGERY
- Your breasts get noticeable fuller at 48-72 hours after your baby is born.
- Baby starts swallowing more frequently within 24-48 hours of this fullness.
- Baby has weight loss that is considered normal and then has weight gain that is considered within normal limits.
YOUR MILK SUPPLY WITH SUBSEQUENT BABIES
The stimulation your breasts get the first time you breastfeed after breast augmentation or reduction can result in the ducts that were severed reconnecting.
One of the first things that I tell a mom who has had breast surgery is that it is not uncommon for much of the work she does with the first baby to have a significant impact on her milk production with subsequent babies.
I had one mom who’d had a breast reduction with an anchor scar. She only knew that the nipple had not been removed, but she didn’t know the specific technique.
This mom had an extremenly low milk supply. She was making only 2/3 oz. every 3 hours.
That was enough for her to keep working at it.
She pumped at every feeding so that once a day her baby could get a bottle of just her breast milk.
She used an SNS much of the time when she supplemented her baby.
She took medications and herbs and saw an acupuncturist.
When she had her second baby, she made 2-3 oz. every 3 hours, and eventually had to supplement as her baby’s needs increased.
With her 3rd baby she had a full milk supply the whole year that she breastfed.
OTHER REASONS FOR LOW SUPPLY WHEN BREASTFEEDING AFTER BREAST SURGERY
There can be other reasons than breast surgery when a woman has a low milk supply
Your breasts are amazing and complex. There can be more than one reason why you have a great milk supply and your friend struggles with hers. It is no different after breast surgery.
Another mom I worked with who’d had a breast reduction had a low milk supply. She worked very hard at trying to bring it up to what her baby needed so she could exclusively breastfeed.
After weeks of disappointing weight checks, she was ready to concede that she never would be able to exclusively breastfeed.
Both she and I assumed her low supply was because of her breast reduction.
I had just returned from a conference where one of the speakers advised checking prolactin levels in moms with low milk supply.
I recommended that she get her prolactin level checked. It came back very low. She went on a medication, Domperidone, which can increase milk supply. It worked beautifully for her and she went on to breastfeed for over 18 months.
FINAL THOUGHTS ON BREASTFEEDING AFTER BREAST SURGERY
Breastfeeding after breast augmentation surgery or breast reduction has improved over the years.
Whether you make a full supply or not, every drop of breastmilk that you give your baby is beneficial. Any length of breastfeeding is also tremendously valuable.
If you want to breastfeed after breast surgery you should educate yourself, have a plan to breastfeed and work with a lactation consultant. Then, wait and see how it goes.
Andrea Tran RN, MA, IBCLC
Andrea has been working with new families as an RN for over 35 years and a Lactation Consultant for over 25 years.
She has her MA in Health and Wellness with a focus in Lactation.