Breast feeding after a breast reduction

The most recent Australian data suggests less than 40% of women who have not had a breast reduction breastfeed their babies for 3months and only 15% make it to 6months.This data is comparable with overseas data on breast feeding rates in normal women.This must be kept in mind when discussing breast feeding after breast reduction.(1)

These figures may be a surprise to many women who have yet to have children. Ninety six per cent  of women try breast feeding but for an infinite variety of reasons cannot or do not continue. Good data on breast feeding rates after breast reduction is surprisingly sparse. The research studies that have been published characteristically have small numbers of patients to report results on.

It does appear fair to say that the published data suggest that  breast feeding is possible after breast reduction surgery. Success or failure with  breast feeding after breast reduction seems to be more likely to be related to non surgical factors than the surgery itself. One of the main important factors is encouragement and support from your doctors and,where required, advice and support from breast feeding experts (lactaction consultants).

The type of breast reduction performed does not seem to be critical as long as the nipple has been left attached to the remaining breast tissue. There are  published reports of successful breast feeding  after inferior, medial, lateral and bipedicle techniques. Vertical (limited scar) techniques are usually medial or lateral pedicle techniques (2,3,4,5,6,7).(A procedure known as "free nipple grafting" where the nipples are actually removed from the breast and replaced as skin grafts at the end of the procedure is very rarely performed. This procedure will not allow breast feeding to occur. This procedure is very rarely used and never likely to be performed on a woman of childbearing age.)

As an example the only published Australian study found that 18 out of  19 women who  had had a physiological operation performed and who wished to breastfeed were are to do so but complimentary feeds were required.

In other published studies  a comparison of breast feeding success rates after breast reduction found very similar success rates (71% for superior pedicle(common pedicle in Vertical reductions),77% for inferior pedicle, 63% horizontal bipedicle procedures).Success was defined as  breast feeding for a minimum of 3 weeks  without any supplementary feeds.(3).

There was no relation to the amount of breast tissue removed and the ability to breast feed.
There was no relation to the time from the breast reduction being performed  to the birth of the child and the ability to breast feed.

Conclusions :

All the published studies report on relatively small numbers of women's experiences but the take home messages  are if you wish to breast feed after breast reduction you should be encouraged to do so.
It is likely (although not guaranteed)  you will succeed  to some extent.
Your ability to breast feed does not appear to be altered by;

a) type of procedure ( except free nipple graft )
b) how much tissue is removed (as long as the remaining tissue keeps it's connection to the nipple)
c) changes to nipple sensitivity
d) the time elapsed from your breast reduction to the time you have your baby.

Resources

1. National Health and Medical Research Council, Feb 2013, Dietary Guidelines for all Australians, (http://www.nhmrc.gov.au/guidelines/publications/n29-n30-n31-n32-n33-n34)
2. Breast feeding after  reduction mammoplasty.  Marshall DR, Callan PP, Nicholson W. British Journal of Plastic  Surgery. 1994 Apr;47(3):167-9
3. Breastfeeding after reduction mammoplasty: a comparison of 3 techniques. Kakagia D, Tripsiannis G, Tsoutsos D.  Annals of Plastic Surgery. 2005 Oct;55(4):343-5.
4. Breastfeeding after vertical reduction mammoplasty suing a superior pedicle. Chercel A, Azzam C, De Mey A. J Plast Reconstructive Aethetic Surgery 2007;60(5):465-70.
5. Breast-feeding after inferior pedicle reduction mammoplasty. Brzozowski D, Niessen M, Evans HB, Hurst LN. Plastic and Reconstructive Surgery, 2000 Feb;105(2):530-4.
6. Lactating and breast-feeding ability following lateral pedicle mammoplasty. Hefter W, Lindholm P, Elvenes OP. British Journal of Plastic Surgery, 2003 Dec;56(8):746-51
7. Breast-feeding ,self exam, and exercise practices before and after reduction mammoplasty. Brown JR, Holton LH 3rd ,Chung TL, Slezak S. Annals of Plastic Surgery 2008 Oct;61(4):375-9