Breast feeding and a breast reduction

Generally, the advice is that there is likely to be a 50 per cent chance that breastfeeding capabilities will be affected by breast surgery of any form, and it is an important factor to consider before undergoing the procedure. Breastfeeding should be discussed with the surgeon fully before any breast surgery.

As with all surgeries, there is a certain element of risk associated with the procedure. If the prospect of being unable to breast feed in the future is a non-negotiable for you, it is recommended that you wait to have a breast reduction until you are finished having a family.

According to the Australian Breastfeeding association, many mothers who have had breast surgery are able to breastfeed, at least to some extent. Some mothers find that they are able to:

• Breastfeed fully (without the need to supplement)
• Breast feed with a galactagogue (a medication to further stimulate your remaining breast tissue) (depending on the reason for a low supply)
• Partially breastfeed (with the need to supplement somewhat)

That being said, the Australian Breast Feeding Association emphasise that is no clear way of knowing before the birth which of the above groups you will fit into. In some ways it can come down to the luck of the draw. The individual situation, how the surgery was done and various other subjective factors will also contribute to the final outcome.

As a rule of thumb, breast reduction surgery is more likely to cause milk supply problems as compared to other breast surgery such as breast augmentation. This can particularly be seen in the patient if the nipple was moved to a new position during the surgery as this can lead to disruption of the nerve supply to the nipple and areola.

"It also depends on to what degree the surgery disrupted the milk glands and milk ducts. However, nerves can regrow, although slowly, and glandular tissue can develop during pregnancy," according to the Australian Breastfeeding Association.

There are different types of reduction surgery, meaning that if you think you may want to breastfeed, you should clearly flag this as a major priority with your surgeon. It may be an area for compromise. Whilst there will never be an absolute guarantee the more breast tissue which is preserved the more likelihood feeding to some extent will be possible. This may come at the cost of a smaller reduction.

Similarly, the Breast Feeding Association  correctly describe breastfeeding as a "feedback loop between nerves, hormones, and ducts any damage to this loop can affect how much milk is produced and delivered to the baby."

For many women, one of the best first steps to take is to contact a breastfeeding counsellor (lactation consultant) well before the birth to discuss your history and priorities. The ongoing contact with this professional after the birth can help to ensure that breastfeeding is going smoothly as well as having a professional on hand if any issues should arise.

For all women (not just those who have had a breast reduction) the research data shows the most important determinants of successful breast feeding experience are 1. An obstetrician and/or midwife who is supportive of breast feeding, and 2. Access to the expert advice and support of a lactation consultant and community infant welfare nurse.

I think the saying goes it takes a village to raise a child!

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