Hi, FrangipaniLou, and thanks for the pm, too - but I'm quite happy to reply on open forum! Nickle, I'd love to hear more of your story - did you try to bf with your first 2? How did it go? What factors do you think made a difference with number 3?

FL, I'm only a few weeks ahead of you (currently 31+6), so really I'm in a similar place as you right now, probably with the same hopes and trepidations that you have, too. I had my reduction at 15, with somewhere over a kg off each side. I was told at the time that the technique he used would mean I would never be able to bf, and after discussing this thoroughly with my very supportive Mum, I accepted this and decided to go ahead with it anyway. I'm now 37, so it's 22 years later, and finally I in a solid relationship with someone who I want to father my children, and I have decided that I want to do everything I possibly can to maximise the chances of breastfeeding.

My reading and research has come up with a few key points.

Firstly that success is less likely, but definitely not impossible, if your surgeon used a technique, as mine did, where the areola is completely removed during the procedure. It has been demonstrated that along with the re-innervation (the nerves grow back) and revascularisation (the blood vessels grow back) it is not uncommon to get re-canalisation (the canals from the milk producing parts of the breast to the nipple grow back). Women who've had surgery more recently are more likely to have had a surgeon who used techniques which preserve the ducts and do not require complete detachment of the nipple and areola.

What makes it more complicated is that the let-down reflex is normally triggered by specialised nerve endings which lie around the outer edge of the areola, which are stimulated when baby sucks, and my areola was significantly re-sized as part of the surgery, so it may be that all of these nerve endings have been removed. My own understanding of let-down is that it can also be triggered by a baby'
s cry, or by thinking of baby, as well, and I have not seen any evidence to know whether or not these 'mental' triggers trigger the reflex via the nerve endings or if they can bypass them. If they bypass them, it'll be more hopeful for me, at least. Also, my understanding is that colostrum is produced, stored and released with a very different process to milk, so although I can also squeeze out a few droplets of colostrum, (and have been able to since about 25 weeks) that is a positive sign for re-canalisation, but not necessarily for milk production or let-down.

Another factor relating to the surgical technique is how many milk ducts were cut and removed in surgery, compared to how many you started off with. Some people have just 3 or 4 to start with, and others up to 9, from memory. If all the production tissue or ducts are removed from 4 ducts when you only had that many to start with, you are unlikely to be successful. But if you have 6 or 7 or more, and 4 were cut, you've still got a good chance as long as the reinnervation, revascularisation, and recanalisation have all occurred.

Time since surgery is also a factor. The longer it has been , and the more menstrual cycles a woman has been through, the more likely it is that recanalisation has occurred. (I don't know if having been on depo provera, and having almost no periods at all for 17 of the 22 years since my surgery, means I don't have the benefit of those years, or not. Had I known, I would have reconsidered using the depo for so long.) Of course we know that revascularisation has occurred quite soon, because if it hadn't, the tissues would die, we'd get very ill, and we'd have a very unsuccessful reduction to contend with in the first few weeks and months. Reinnervation can be approximated by the amount of nipple, areola and breast sensation we have, but the innervation, or lack of it, of the skin does not always relate to innervation of the deeper, milk producing tissues.

As I had my surgery at 15, I continued to grow for a few years afterwards, and I went from a size 12 with an unmeasurable cup size to a 12C in the surgery, and over the next 2-3 years grew to a 12F/FF, where I've stayed until now (pregnancy has taken me to a 12 G so far). I feel that the few years of puberty and hormones and growth I had after the surgery may have been a positive factor for me as well.

I am preparing to act on the best case scenario, which is that I have enough functional breast tissue to have a reasonable chance at feeding my baby. There is nothing else I can do to change the breasts that I have, and I will have to deal with it is this is not the case, but I am planning everything else around my delivery to give me and baby every chance of being as successful as my breast let me be. That means that I will know for sure, if I end up fully or partially formula feeding, that I have done everything in my power to give my baby the best possible start.

Obviously education and research now is a big part of my preparation, and I will also go to an ABA class, with my partner, and possible see an LC before I'm due as well.

I have also made birth preference decisions based on all of the factors which have a greater likelihood of leading to successful breast-feeding - vaginal delivery, so both babe and I get all the normal hormones we should to trigger lactation and feeding, I want to avoid pethedine which might make baby dopey to start with, and have not consented to the Hep B vaccine which can make baby irritable and feel unwell for a few days. I want baby to have immediate skin to skin contact after birth, with me, preferably, but if that's not possible, then with baby's daddy instead. And I want an un-managed third stage, so that the cord can be left to pulse out, and baby gets all that blood which is thought to help it cope with the days it can take before the milk comes in. I want to avoid induction and epidural, if possible, because of the cascade of intervention leading to a greater likelihood of Caesarian section, which means all those good birth hormones will be missing for both of us. I'm happy to use gas, heat, TENS, a bath, and active labour techniques for pain control. I want baby rooming in at all times, and on no account is anyone but the LC who I'll see afterwards to suggest to me that we top up with formula. Most of these ideas come from the 'sample' birth plan on the ABA website, where they compile all the birth-related factors which may help lead to successful breastfeeding.

And my partner is on board with all of this. He might not remember all the anatomical detail, but he knows enough to understand why it's so important to me, and what he needs to do to support baby and I in this challenge.

The best resource I have found - for scientific research, rather than anecdotes - is La Leche League's website: http://www.llli.org/nb/nbsurgery.html. Most of the links are on this page.

Sorry it's so long, but I hope that some or all of the above is interesting and useful for you. I wonder if there are many others out there in the same boat?