Breast Augmentation & Breast Reduction and Breastfeeding – Can I?

            There are millions of women of childbearing age who have had a breast reduction, breast augmentation, and breast biopsies. All of these procedures can affect breastfeeding. They have the potential to affect milk supply and whether your baby can get out the milk that you make. These surgeries can also affect how much impact engorgement has on the milk-producing cells.

The Word on the Street

                        Some women have these surgeries at times when they are so far from having babies that whether or not it may impact breastfeeding is the furthest thing from their minds. It would be nice if surgeons always brought it up or, better yet, did procedures that preserved a woman’s ability to breastfeed.

Some plastic surgeons tell women that they probably won’t be able to breastfeed after some of the procedures. Other surgeons say to women that it won’t have any impact on breastfeeding. Neither is entirely true. Other women, usually other mothers, can be a source of information as well as misinformation too.

It is true that anecdotal reports contribute a lot to what we know. Not everything related to breastfeeding is subjected to rigorous scientific studies. Or even substandard scientific studies. Sometimes we just have to go on our experience.

Reasons for Breast Altering Surgeries

Breast Reductions

  • Very large breasts can cause back pain, neck pain, and hunched shoulders because of the weight
  • The weight of the breasts can result in her bra straps creating shoulder grooves
  • Large breasts can affect the type of exercise women with large breasts can comfortably participate in
  • Cosmetic reasons

Types of Surgeries

Breast reduction and breastfeeding

There are two different ways to decrease the size of a woman’s breasts

  • Liposuction
    • While liposuction removes only fat tissue, the glandular tissue can be damaged from liposuction since they can’t see the inside of the breast during the procedure
    • It is not very effective for very large breasts in reducing breast size significantly
  • Surgery
    • Surgical methods can vary as to where the incision is made and therefore, what type of scar a woman will have
    • Surgical methods also can vary regarding what they do with the nipple

Nipples and breast reduction and breastfeeding

  • Nipples are how the milk gets from the glands in the breast out of your body (you probably knew that)
  • If the nipple is completely removed and repositioned, this will sever ducts
  • If the nipple is left attached, this will help preserve those connections
  • There are variations on how that procedure is done and referred to as inferior or superior pedicle techniques
    • Inferior pedicle techniques are believed to result in better breastfeeding outcomes

You can begin to see how complicated this can get and how there are so many factors that can affect breastfeeding success after breast reduction. This is the reason why some women with reductions have better milk supplies than other women who have had reductions.

Breast Augmentation and Breastfeeding

One of the first things I ask women who have had breast augmentation is why they had it done. I’m not just nosy. It’s true that most women have implants so they will have larger breasts. However, some women have it done because they have very abnormally shaped breasts or one breast is very small compared to the other. This can be a sign of insufficient glandular tissue, which means there just are not enough glands to produce milk. Breasts like this are sometimes referred to as tubular shaped.

How Implants Can Affect Breastfeeding

Some people mistakenly think that since no breast tissue is being removed, breast augmentation should not affect breastfeeding. This is not the case. Just as with breast reduction, breast augmentation has different procedures.

Incision Locations

  • Under the breast, in the crease
  • In the armpit
  • Through an incision just above the belly button – I rarely work with women who have had this incision, so I am not sure how frequently this procedure is done
  • Areolar edge – this is great for concealing the scar but can sever a lot of the ducts and is considered the method that can have the most significant impact on breastfeeding. It is called a periareolar incision
  •  Size
    • 150 cc’s and larger
    • Larger sizes can increase the impact of engorgement. The pressure from the implant can mimic severe, unrelieved engorgement. This puts pressure on the milk-producing cells, which can damage those cells if it is prolonged.  Swelling hopefully will decrease with ice packs, the pressure from the implant will not

        Education, Preparation, and Resources

As with most things related to breastfeeding, education can make a significant difference in how breast surgery can impact breastfeeding. In addition to reading this article, check out these websites.

http://bfar.org/index.shtml

https://www.americanboardcosmeticsurgery.org/procedure-learning-center/breast/breast-reduction-guide/

https://www.americanboardcosmeticsurgery.org/procedure-learning-center/breast/breast-augmentation-guide/

You will notice that the American board of cosmetic surgery does not mention breastfeeding at all in their descriptions of procedures.

The internet can be a plethora of information. That’s where you’re reading this, aren’t you? I’m sure you know by now though, not everything you read on the internet is true, or accurate. It’s up to the reader to figure out which is and which isn’t.

I recommend reading these books:

Defining Your Own Success by Diana West

Breastfeeding After Breast and Nipple Procedures, also by Diana West and Elliott Hirsch

 

 

 

Breastfeeding Plan after Birth

It’s very important to have a plan for what you are going to do after your baby is born.

Photo by Cathryn Lavery on Unsplash

  • Breastfeed early and often
  • Start using a breastpump within 12 hours of giving birth
  • Use a breast pump 4-8 times every 24 hours
  • Continue pumping at this rate until your baby is thriving on your breastmilk alone
  • Herbs or medications can increase milk production
    • Do some research and decide if this is something that you want to do

Wait and See

With any breast surgery, you will not know what the impact it is going to have on your supply, until you have a supply. I have had moms who had breast reductions who never saw a drop of milk. I have also had moms who had a full supply with their first baby. With breast augmentation, most moms will see drops at a minimum. Many will have full milk supplies. With both types of procedures, many moms will fall somewhere in between. Many of those moms do a lot to optimize milk production and end up with full supplies.

Seeing colostrum is encouraging, but not a guarantee that you will not have issues with your supply.

You have to wait and see what happens when your milk comes is. If a lot of your breast tissue has been removed, you may not experience a lot of fullness or engorgement. If you have had a breast augmentation with an incision around your areola, you may get very engorged.

When your milk comes in, you have to see if it can get out. If a lot of the ducts have been severed, there is no place for the milk to get out. Engorgement can be severe and eventually the milk dries up. Be vigilant with managing engorgement. Breastfeed frequently and apply ice packs for 15-20 minutes (never longer) every couple of hours.

When your baby breastfeeds, listen for a lot of swallowing. If you are pumping, look to see how much milk is spraying out. Pay attention to whether your breasts soften with feedings.

Just like most of the things I write about, it’s best to work with a lactation consultant because you can’t just make a check list to figure out if everything is working the way it should.

However, look for these encouraging signs

  • Breasts get noticeable fuller at 48-72 hours after your baby is born
  • Baby starts swallowing more frequently within 24-48 hours of this fullness
  • Baby has weight loss that is considered normal and then has weight gain that is considered within normal limits

When you have another baby

One of the first things that I tell a mom who has had breast surgery is that it is not uncommon for much of the work she does with the first baby to have a significant impact on her milk production with subsequent babies. The ducts can reconnect with stimulation.

I had one mom, who is one of my most memorable patients. She’d had a breast reduction with an anchor scar. She only knew that the nipple had not been removed, but she didn’t know the specific technique. She had a very, very low supply, making only 2/3 of an oz. every 3 hours. For her though, it was enough to keep working at it. She pumped at every feeding so that once a day her baby could get a bottle of just her breast milk. She used an SNS for most supplementation when she was with her baby. She took medications and herbs and saw an acupuncturist. When she had her second baby, she made 2-3 oz. every 3 hours, and eventually had to supplement as her baby’s needs increased. With her 3rd baby she had a full milk supply the whole year that she breastfed.

More than one reason for low supply

Your breasts are amazing and complex. There can be more than one reason why you have a great milk supply and your friend struggles with hers. It is no different after breast surgery.

Another story I want to share is a mom I worked with who’d had breast reduction and had a low supply. She worked very hard at trying to bring it up to what her baby needed so she could exclusively breastfeed. After weeks of disappointing weight checks she was ready to concede that she never would be able to. We assumed her low supply was because of her breast reduction. I had just returned from a conference where one of the speakers said that we should be checking prolactin levels in moms with low supply. I recommended that she get her prolactin level checked. It came back very low. She went on a medication, Domperidone, which can increase milk supply. It worked beautifully for her and she went on to breastfeed for over 18 months.

Find out more about low supply in this post:

How to Increase Milk Supply

One Last Thought

After having either an augmentation surgery or breast reduction, breastfeeding can be impacted. Whether you make a full supply or not, every drop of breastmilk that you give your baby is benefitial. Any length of breastfeeding is also. I recommend any mom educate herself, have a plan to breastfeed and work with a lactation consultant. Then, wait and see how it goes.

If you had breast surgery, what did your surgeon tell you about how it would affect breastfeeding? Did breastfeeding turn out the way you were expecting? Let me know by leaving a comment?

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