Having breast reduction surgery before you have babies isn’t a deal-breaker for breastfeeding. Honestly, I know many families who thought they were done having children. They had the surgery and then welcomed another little surprise. Things happen, and many pregnancies are unplanned. Is breastfeeding after breast reduction surgery possible? Let’s talk about how breast reduction surgery can impact breastfeeding, or if it does at all.
HOW COMMON IS BREAST REDUCTION SURGERY
According to the American Society of Plastic Surgeons national plastic surgery statistics, 43,591 breast reduction procedures were performed during 2018. This number likely rises more than 10% every year. The procedure has tremendously high patient satisfaction and scores a 98% .
BASICS OF BREAST REDUCTION
There are many reasons why someone might choose to have breast reduction surgery. Consider that very large breasts can add a significant amount of weight to a person’s frame. It can cause back problems and overall daily discomfort, and can affect the quality of life. As with any surgery, there is a lot to consider. This is a surgery that is sometimes considered cosmetic or elective (depending on the reason it is being performed). So much depends on how the surgery is done. How much tissue is removed, and how long it has been between surgery and pregnancy can make a difference.
RECANALIZATION
Milk ducts may be severed during breast surgery. Because your body is amazing, it is possible these milk ducts can reconnect. This is called recanalization. Recanalization is the process during which previously severed ducts reconnect or new ductal pathways develop. The most extensive instances of recanalization have been seen in direct response to lactation. Any duration of lactation seems to prompt the mammary system to reestablish new ducts. The extent to which recanalization will occur seems to correspond directly with the extent of the mother’s previous lactation experiences.
A mother who had an incomplete supply with her previous baby may find that she has more milk with her next baby. In some mothers, recanalization has resulted in a complete milk supply for subsequent children. A slight amount of lactation tissue is also formed in response to the hormones that are secreted during each menstruation. Therefore, the longer the mother has lactated and the more menstrual cycles she has experienced, the greater the potential for recanalization. Keep in mind lactation potential is limited by the extent of the surgery.
One other angle regarding what happens to ducts during surgery is how many ducts the mother actually has. It has recently been discovered that the number of ducts that actually open out to the nipple can vary much more widely than we have thought. Researchers found an average of nine ducts that came all the way through the nipple. However, as few as four were also observed. A woman with nine ducts can afford to lose a couple. A woman with only four really can’t afford to lose any. Though she may still have enough milk-making ability, if the milk can’t get out then the baby can’t get it. That area of the breast will stop producing.
REINNERVATION
The critical nerve of lactation is the fourth intercostal nerve. It is located around the 4:00 position on the left breast and the 8:00 position on the right. This nerve is the primary messenger to the brain for the release of prolactin and oxytocin. It’s the hormone oxytocin which triggers milk ejection. Milk ejection does not happen as easily when this nerve pathway is injured. Fortunately, nerves can regenerate and reconnect through a process called reinnervation. The process of reinnervation is not influenced by the process of lactation or previous lactation events. It occurs at a consistent growth rate of 1 mm per month.
When a normal response to touch and temperature is regained, it indicates that the nerve infrastructure is improving. This enhances its ability to conduct the appropriate sensations to the pituitary gland for the release of prolactin and oxytocin. How well the mammary glands respond to baby’s demand is dependent upon the state of both the glands and the ducts. Nonetheless, the more time that has elapsed since the surgery, the greater the chances that the nerves critical to lactation have regenerated. You can read more interesting stuff about how your body recovers from breast reduction surgery.
As you can see, there are many things to consider when preparing to breastfeed after breast reduction surgery. It’s not just the milk ducts and the reinnervation of the nerves. We have to acknowledge how well milk glands functioned prior to the surgery and if there is additional lactation history. Also, consider how much time has passed since the surgery. We also need to examine how you are managing breastfeeding after baby is born.
BREASTFEEDING MANAGEMENT
Put the baby to breast as soon as possible. Keep baby skin to skin, and feed often. You can pump to maximize stimulation. Milk removal in the first 2 weeks after birth is crucial to developing a good supply. Breastfeed frequently and add in some pumping as well. This will help signal your hormones that more milk is necessary.
PUMPING
Pumping can be frustrating and time-consuming. Best results come when you are consistent, using a hospital-grade double electric pump and correct size flanges. Contact a lactation consultant if you are unsure about sizing. Pumping is so visual; it can be discouraging if you are only seeing small amounts of milk when you pump. Remind yourself that the act of pumping helps to signal your body to make milk. You do not need to be pumping large volumes of milk to make progress in this area.
LACTATION SUPPORT
Working with a lactation consultant is invaluable during this time. It helps to meet prior to having the baby and make a plan for after delivery. Meeting regularly after the baby is born can help to increase confidence. It can also help you feel better about feedings overall.
RESOURCES
There are a couple of wonderful resources for breastfeeding parents who have undergone breast reduction surgery and plan to breastfeed. The first one is Breastfeeding after Breast and Nipple Surgeries, or BFAR. BFAR is a very informative website to get you started.
Defining Your Own Success: Breastfeeding After Breast Reduction Surgery by Diana West is a fantastic book. Diana West is someone who has experience with breastfeeding after breast reduction. It’s a must-read for anyone who wants to learn more.
Breast reduction surgery is one of those areas that no one can predict. It’s kind of a wait-and-see. I have met many breastfeeding parents who have had breast reduction surgery and go on to breastfeed successfully. Remember any amount of milk you can give your baby is beneficial.
