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Breastfeeding after a breast reduction

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baby breastfeeding

Written by Janelle Brennand Armstrong

Ottawa Breastfeeding Buddies, Ottawa Public Health

Breastfeeding can be hard, period. But if you have had a breast reduction, you may not be sure if you will be able to breastfeed at all. While I am no expert, I am happy to tell you from experience that it is possible!

I had my reduction in 2004, at the age of 21. After the operation, my surgeon told me I would have an 80 percent chance (on each breast) of being able to breastfeed, when the time came. Whether he meant exclusively or with supplementation (i.e., formula) I am not sure, and at the time, I didn't think to ask.

Fast forward to 2013 - I was now married and newly pregnant. Over the next nine months I became increasingly concerned about my ability to breastfeed, given my breast reduction. I tried doing research, but most of what I read gave little hope for breastfeeding exclusively (without topping up with formula). In general, it seemed that most women who have had this surgery have a good chance of producing "some" milk, but not enough to feed a child with their breast milk alone.

"Defining Your Own Success: Breastfeeding After Breast Reduction Surgery" (by Diana West) is generally considered the best book on the topic. I learned from this book that the type of surgery I had (keeping the nipples attached during surgery) was better than other types at preserving a woman's chance to breastfeed. I also learned that breast tissue can regenerate, somewhat -- the longer the time between surgery and when you begin breastfeeding, the better.  Regeneration can also happen as a result of breastfeeding itself. Many women have a hard time producing enough milk for their first child, but the simple act of breastfeeding can mean they are able to produce more milk for their next children, sometimes enough to exclusively breastfeed.  While this was all good news, the book did not seem to give much hope for being able to exclusively breastfeed a first child. 

I looked into at-breast supplementation, which is a way of providing formula (or pumped breast milk) to a baby through a tube that is placed at your nipple. This allows the child to receive formula/pumped milk while still latching to the breast and encouraging milk production. Meanwhile, my pregnancy was progressing. Sometime in my third trimester I began leaking colostrum (the nutrient-dense liquid that is produced before a woman's milk comes in).  As my due date approached, my doula encouraged me to try to express some of that colostrum into a container and to store it in our freezer. "Every drop counts", she said.

When our daughter was born, I started breastfeeding her almost immediately. The hospital was aware of my reduction and advised me to start pumping as soon as possible, to encourage milk production. I was still only producing colostrum, but I put my new baby to my breasts every two hours, and hoped that my milk would come in. I pumped several times a day. I put a hot compress to my breasts before each feeding and massaged them often to encourage milk flow and help prevent engorgement. On day 4, my milk was starting to come in but wasn't quite enough to fully support our daughter. Our doula helped us try out an at-breast supplementation system, but I was tired and overwhelmed. "When the tears flow, the milk flows", she reassured me. We gave up on the at-breast supplementation system and tried a bottle instead (a few mL of formula once a day after a feed). At our doula's advice, I started taking blessed thistle and fenugreek, two herbal remedies for increasing milk production. I started eating and drinking anything that might increase my milk supply, including oatmeal, brewer's yeast, mother's milk tea, and plenty of water.

Much to my delight, I continued to produce more milk, and our daughter continued to gain weight. By the time she was 6 days old we were no longer using formula. I continued nursing every 2 hours during the day and every three hours at night, and pumping 2-5 times a day (always immediately following a feed).  Within a couple weeks of our daughter's birth, she was at my breast exclusively (no more bottles of pumped milk). I became more comfortable with my milk supply, and stopped pumping altogether when our daughter was about 6 weeks old.  Our baby was of average weight and I was now very confident that my milk supply was meeting her needs. I breastfed our daughter until she was 16 months and 9 days old. I found it to be an incredibly wonderful and rewarding experience. I have also found that even though I am no longer nursing our daughter, my breasts have much more feeling than they had before I began breastfeeding. I truly believe that breastfeeding my daughter has caused further regeneration of my breast tissue.

I cannot say exactly what it was that allowed me to breastfeed exclusively. It was likely a combination of several factors - a skilled surgeon using a modern technique (not removing and reattaching the nipple), a long length of time between surgery and breastfeeding, early and frequent nursing and pumping, herbal remedies, lots of water, and lucky genetics. I have heard of other women having success with other factors, such as acupuncture, ultrasound therapy, other herbal remedies, as well as medication (ie., domperidone). For more information and support, I encourage you to join the closed (private) Facebook group, "Breastfeeding After Reduction (BFAR)". I wish I had known about it when I was breastfeeding!

I know that my story is not the norm, and that I was lucky.  Nevertheless, I feel it is important to share my story so that other women who have had a breast reduction can know that it is, in fact, possible to not only breastfeed after reduction, but to breastfeed your first child exclusively.  If you are hoping to breastfeed after reduction, don't count yourself out!