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Breastfeeding After Breast Surgery

Breastfeeding And Breast Surgery Both Trending Upwards

These days, many more women are having breast surgery as compared to the past, and breastfeeding is also gaining in popularity. These two trends are at odds, as breast surgery may adversely affect your ability to successfully feed your new baby. In the last couple of years, cosmetic breast surgery has actually begun trending downward. Is this the start of a new trend? Or, just a hiccup in the longer-time-scale trend? We shall see.

If you've had breast surgery, even in the distant past, inform your baby's physician as well as your lactation consultant. Chances are very good that you can still breastfeed. Only a few decades ago, this would not be the case, but new surgical procedures that preserve breast tissues and function are now common. You may need to supplement with infant formula, or use the services of a human milk bank, as your supply may be lessened.

Also, nursing can be challenging, even in Moms without breast surgery. Know that there are ways to increase milk supply, from pumping, to ingesting galactogues, foods and supplements that increase milk production. You must keep trying if breastfeeding is your goal, and don't be hard on yourself. Just do the best you can, and be satisfied to know that you did all you could to help your baby have the added benefit of being breastfed.

Reasons For Breast Surgery

Whether it's a breast reduction, a lift, or augmentation, cosmetic breast surgery is on the rise. People choose breast surgery for a number of reasons. If you've had such a surgery, you already know this. Sometimes the added weight of large breasts causes constant pain, back strain, postural issues, and even headaches. Reduction procedures can literally take pounds and pounds off, making it easier for some women to function every day.

Sometimes a woman just doesn't feel comfortable with her appearance, either because her breasts are too large or too small or not the shape she'd prefer. Some people wish for others to see them differently, more like how they see themselves in their own minds. Some women choose surgery to feel more confident.

Breast Surgery May Mean Less Milk

As stated above, breast surgery can negatively affect a person's ability to provide milk to their baby. This is an actual risk, and not an urban legend. Breast reduction surgery has the highest probability of affecting a mother's milk supply, of all breast surgery categories.

According to the Center for Disease Control and Prevention, it's common for new Moms who have undergone breast and/or nipple surgery to produce less milk, though some mothers will be able to provide the usual full supply.

And, the CDC notes, even if a full supply is not available, a mother and baby can still have a fulfilling and successful breastfeeding experience. Such parents are encourages to supplement with baby formula. Some breast milk is always better than none.

Breast Augmentation, Lift, & Reduction

The breast tissue is comprised of fat, nerves, blood vessels, mammary glands, and the mammary ducts. These all may be affected by breast augmentation, lift, and reduction procedures. Depending on how the individual patient, which procedure was done, and how it was done, this can either severely impact supply or have a negligible effect.

According to forum posts on this topic, most women who have had breast surgery were able to breastfeed without issue, even in instances where the nipples were moved. New Moms did note that relocated nipples sometimes affected supply. Also, some Moms required the use of a nipple shield, as their full breast, already made larger by surgery, were not shaped ideally for latching once milk came in, as nipples sometimes tend to be flatter.

Breast Implants

While breastfeeding is a timeless human activity as old as sleeping or eating, breast implants have only been used since the 1960s, and only really gained popularity in the late-eighties and nineties.

Usually, implants affect milk supply in predictable ways. Implants placed under the layers of muscle tissue, where the breast sits against the ribcage, is called an infra-mammary procedure. Such operations affect milk production minimally, if at all. The breasts are essentially left intact, and nothing is cut, nothing is moved within the breast.

Implants placed above the muscle tissue layer, that is, within the breast tissue itself, can impact milk supply to a far greater degree. Also, if the incision was from under the armpits, rather than through the nipple, success will be more likely, And again, the individual patient, as well as the surgeon, all play roles in determining outcome.

In 2001 it was decided by the American Academy of Pediatrics that silicone implants are not contraindicated for breastfeeding Moms. Still, some women who choose to get implants start off with hypoplastic breasts, meaning their breasts had insufficient glandular tissue to start with. That condition, in and and of itself, would potentially have dampened milk production, even had surgery not been undertaken.

Reduction Mammoplasty And What It Means For Breastfeeding

Reduction mammoplasty is another name for breast reduction surgery. Breastfeeding after reduction is known by its acronym: BFAR. Women who have undergone BFAR may still successfully breastfeed their baby. Milk is produced in the lobules and funnels down through a series of ducts whee it can exit the breast via the nipple. In breast reduction surgery, some of these channels may be destroyed or removed entirely.

You may be upset that your breast are growing and growing, but rest assured, after your pregnancy is over, most women experience a return to the pre-pregnancy size.

A key factor that plays a role in the impact breast reduction may have on nursing is how much tissue was removed. Of course, the more tissue that's removed, the less a person's capacity will be to later produce milk. When a slight reduction is size is that goal, sometimes liposuction alone is performed.

For more serious reductions in size, an incision is made and breast tissue, including adipose (fat) tissue, is removed. Surgeons often remove glandular tissue and ducts that allow milk to flow to the nipples. As mentioned above, the nipples may also be relocated.

Sometimes, when breasts are significantly reduced in volume during surgery, the nipple tissue is moved. This may seem difficult to believe, but it's true. In the process, the nipples are sometimes completely detached from the milk ducts that branch out from each nipple, and the tissue under the nipple is completely removed. This is also referred to as a "free nipple graft." (In most instances, the nipples and areola remain attached to their milk ducts, nerves, and blood supply.)

Nerves are also sometimes severed, and if the nerves are connected to the letdown reflex, which triggers more milk production in the body, milk supply will also be affected.

Detached Nipples Do Not Mean Failure

When nipples are completely detached and then reattached, this can severely impact milk supply. Even if your areola and nipples were scarred all around in a complete circle, that does not indicate with any kind of certainty that your nipples were completely severed from all of the milk ducts. Breast reduction surgery has the highest chance of affecting milk production, especially if the nipples were completely severed from the milk ducts when moved.

A 2017 review of over fifty research studies on breast reduction concluded that when the nipple and areola remain attached, and the column of parenchyma from the nipple areola complex to the chest wall (subareolar parenchyma) remained intact, there was a 100% chance of success with feeding.

When some of the milk ducts were destroyed or removed, the likelihood of successful breastfeeding dropped to 75%. And, when a nipple is totally removed and re-grafted, the figure drops again, this time to only 4%.

Recannualization Of The Milk Ducts

Incredibly, even in the case of completely severed milk ducts, new channels can form new routes for the milk to flow. This is referred to as recannualization. Ducts can even sometimes regrow so that milk can exit the breasts through nipples that have been moved to a new position. The body will, on its own, find a new route for the milk to travel down and exit the body. Lactating, and breastfeeding, can actually encourage this process.

Severed Nerves Regrow?!

Severed nerves can even regrow, and over time sensation in breast tissue after surgery may even improve. This is essential because the 4th intercostal nerve carries impulses to the brain which signal hormones like oxytocin and prolactin to be released, both of which are necessary for increased milk production. This process takes time.

Is it Safe To Provide Milk If I Have Silicone Implants?

There have really been no reports of recent clinical problems regarding infants whose mothers have silicone implants. Urban myths persist because a few decades ago, there had been a serious issue, but it was only a few isolated incidents.

Can I Provide Enough Milk Even After Breast Surgery?

As with all newborns, babies whose Moms have had breast surgery should have their weight carefully tracked to be sure they're getting enough nutrition. If you're direct feeding, it's difficult to gauge exactly how much milk your baby has had, unless you weight the baby before and after feeding. But when you pump, you will be able to know exactly how much milk there is, just by looking at the bottle. The amount of milk changes based on a number of factors, some of which are controllable.

Depending on the nature of the surgery, how many ducts were completely severed, how the breast tissue grew back and regenerated, and how long ago the surgery was performed, there will be a lesser or greater extent of loss of milk. There is seldom a complete loss of milk, in any case. Your surgeon may have warned you that breastfeeding will be impossible, but often, patients are told the worst possible scenario, and the actual situation may not be quite so dire.

Studies show that surgery technique matters most. When the column of tissue, going from the nipple areola complex to the chest wall remained intact, breast reduction surgery impacts milk supply negligably, if at all.

Don't Quit Even If You're Not Getting A Lot

If you're not getting sufficient milk supply, especially immediately following birth, know that you should not give up. The amount of milk you produce is directly correlated with how much milk you take from your breasts. Therefore, to increase supply, simply take more. It's a "positive feedback loop." And so, the only mathematically sound way to answer this dilemma is to feed and pump more frequently, as you can't increase the amount taken at each feeding, if you're exhausting your supply at those times.

Breasts May Not Engorge Fully

After a breast reduction surgery, you may experience more engorgement with one breast than the other. It's also possible that portions of your breasts feel more engorged and tight, while other parts remain more flaccid. Engorgement may hurt. That's true for many women, and not just those who have previously undergone reduction surgery.

Producing Less Milk May Be Emotionally Challenging

Some women find that their ability to breastfeed having been affected by past breast surgery is cause for deep emotional turmoil. They may feel guilty. They may blame themselves for opting for a surgery that would affect them later in life. Forgive yourself. You did the best you could, at the time. It's not worth stressing over. Seek emotional support when necessary. Message boards may be a good start; if you're still feeling down, it may be time to talk with a mental health professional.

Do Certain Foods Increase Supply?

Actually, there is a longstanding tradition in India, Europe, and other places regrading traditional foods and herbs for increasing the amount of milk produced. These have, in recent decades, been clinically studied. It turns out, phytochemicals in the vegetables and other plants that are suggested that a new Mom eats and drinks, can drastically affect supply.

And so, anecdotal accounts and tradition have recently been proven to be rooted in actualy fact and science. That is to say, in studies positive correlations were measurable, and by any standard, quite high. Please see out article on the topic by following this link.

Transgender People and Chestfeeding

Transgender parents who have undergone top surgery may choose to chestfeed, when possible. Baby formula and milk bank human Pasteurized milk may be necessary to fill gaps in production. Specific medications to induce lactation may also be prescribed by a doctor.

Sexual Reassignment Surgery

Also gaining popularity is sexual reassignment surgery, and the Transgender Movement. Someone transitioning to another gender may opt for breast surgery, either to increase size, or sometimes eliminate the appearance of female breast entirely. Some people who opt for this surgery nevertheless later choose to breastfeed, or "chestfeed" as trans people call it.

Mastectomy and Breastfeeding

Sometimes breast surgery is performed as a medical necessity and not an elective surgery for cosmetic reasons. There are many reasons for breast surgery, including cancer and serious other health issues. Some women were treated for cancer in a way that included the partial or total mastectomy.

One in twenty women develop breast cancer during their lifetime. Both partial and total mastectomies remove breast tissue; it's just a matter of degree for each one.

A total mastectomy removes around 95% of breast parenchyma, or tissue. There are simple mastectomies, which leave a smooth chest wall devoid of any breast tissue, nipple or areola. There's skin-sparing mastectomy, which remove all breast tissue, but leave a skin flap for future reconstruction and cosmetic surgery. There's also nipple-sparing mastectomies, which remove the breast tissue, but leave the skin, areola, and nipples.

If you've had a unilateral mastectomy, know that your remaining breast can produce enough milk on its own for a growing baby. Partial mastectomies, as well as radiation therapy, may lower milk output significantly. Radiation brings about irreversible histopathologic changes to breast tissue including fibrosis; the remaining breast tissue is essentially turned to scar tissue.

Psychosocial challenges to such parents should be acknowledged. It's not easy breastfeeding under ideal conditions; after cancer treatment, it is often quite challenging and this sub-group of Moms need special attention from their health care team.

A partial mastectomy means removing only a portion of the breast tissue. Still, as with any breast surgery that reduces tissue and cuts into the parenchyma are made, damage to nerves crucial to the milk ejection reflex may have been done.

Breastfeeding Cannot Cause Cancer

Breastfeeding cannot cause the breast cancer to "come back" or to begin in the first place. Breastfeeding is a healthy, natural activity that our bodies are made to perform.

If you can breastfeed after cancer treatment, know that it cannot possibly adversely affect your cancer status. Nor is it the case that your milk is somehow tainted. Of course, be sure none of the drugs you are taking are contraindicated for breastfeeding. If you;'re not sure, carefully go over your list of prescriptions with your baby's doctor.

Cancer Treatment Provides Unique Challenges

Some cancer medications might be contraindicated for breastfeeding. In such situations that a patient is continuing to receive treatment after the baby is born, breastfeeding is not an option. It's more important to treat your cancer than breastfeed. Other medications or therapies used in the treatment of cancer may decrease milk production as well.

A Lumpectomy May Scar, But That's It

A surgical biopsy, or "lumpectomy," as it's often called, removes breast tissue for lab assessment. And, it's a common procedure. Of course, such a procedures essentially rips a piece of the breast out and often leaves a scar where it was done. You would expect as much! Even so, biopsies will not affect milk volume, nor will any other issues be created or risks increased. Considering the total mass of breast tissue, what's removed is insignificant.





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