bf after reduction

Ok, so I'm 27 weeks pg and now able to hand express 3 drops of colostrum from each side, which I'm very excited about.
I had a breast reduction of 1 kg from each side about 18 years ago as well as a duct removed last year because of Dodgy cells detected.
I'm interested to hear other bb members experiences( I'm hoping for some positive ones) about bf after reduction surgery.
Did you use a pump after birth to build your supply? Did you get additional support from a lactation consultant?
Could you exclusively bf?
If you supplemented, did you use a sns?
If you supplemented with formula, which one did you use?
Thanks :-)

Hi. I haven't personally been through this but I have supported a few women who have had a breast reduction. Unfortunately out of the four I have assisted none of them were able to b/f BUT this doesn't mean you wont be able to.
Definitely get the assistance of a lactation consultant, preferably before you give birth, to help you prepare and try to establish b/f. The LC will be able to guide you what to do to give you the best chance of b/f.
I wish you the best of luck and hope that you will be able to b/f your little bubba.

Oh, I have lots to tell you... I have had two reductions, one at 12 and again at 22ish. Miss P is my third child, the only one I have successfully BF. She is 19 months and still going strong. Google 'Defining your own success, breastfeeding after reduction' it's a great book full of real stories, I found it a fantastic cheering squad. I did have to order it from the USA.

I have to get myself and the kidlets ready as I have to go to work. Will be back later (might be tomorrow!) to post more.

Hi FL
I don't have personal experience, but have you had a look at the ABA website - there's info on there for women who've had reduction surgery. Also, there's a great book called "Making more milk" which covers this to some extent also. You may also find it very helpful to contact a lactation consultant now and form a relationship and make plans.
It is generally possible to breastfeed, though not always exclusively - but you can define your own success. Any breast milk is great :)

I knew a woman who could only BF from one breast after having work done on it. The solo breast did the work of two :)

You should PM Kazbah about this.

One of my besties got nothing (not even colostrum or sore/enlarged) from either boob with her daughter but she has 2 reductions plus removal of keloid (sp?) scaring, I know 2 other women who successfully fed but had to work at first to get supply up & going.
From what I know of you are getting colostrum then that's a great sign.

sent from my watzamajig so may not make sense....

I saw my LC during pre natal care and yes, being able to express colostrum is a fantastic sign because the same pathways / ducts etc are going to be used to produce and release milk. You are in a great place to start your BF journey.

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?

Hi. Yes, it can be done with time ad patience. Luck and support. Will put a proper post on when I'm on my puter.

sent from the Hellmouth.

Wow! When I posted this thread this morning, I had no idea I'd get such a generous response. Thanks!

I'm planning on linking in with a highly recommended lactation consultant about 6 weeks before my EDD to assess my breast tissue and help me put together a BF plan. I'll follow her lead as to whether we hire a pump.
We did the ABA course last moth, which was great for both of us. I've joined the BFAR site(Breastfeeding After Reduction) and they are very supportive and the site has loads of info on it. Nickle and MadB the author of the books that you've mentioned were written by the originator of the BFAR site so I think Ill borrow them from ABA once I've finished the breastfeeding naturally and Ina May's guide to Childbirth!(In amongst reading 50 shades of grey!) Pholi, I echo your birth preferences and I'll add the delaying of the hep b vaccine to mine as well.
I even contacted the hospital where the surgery was done but because it was so long ago, the records have been destroyed, but I have the name of the dr in case I decide to ask him what techniques he used 18 years ago but with colostrum coming, it might not be necessary.
We are also in the process of booking a Doula- 4 on the list and 1 I haven't gelled with so far. Hopefully having a Doula will help with bf too!
I'm also interested in hearing from women too who have used the supplementary feeding system that attaches to your nipple. I hear its a challenge to use.
Onyx, that a great story- I thought that how it would work for me too after issues last year with my right breast- I guess if she did it with 1 working them I'm doubly blessed!
Looking forward to hearing your story Nickle!
Thanks everyone, if you think of anything else, I'm happy to hear suggestions :-)

Sounds like a great plan!!!!

Finally finished work and winding down before I go to sleep!

My previous post said that I had my first reduction at 12. That was a typo, I was 17! I had a traditional anchor incision, my nipple and areola were completely removed and my areola was trimmed markedly. I had 1.3kg removed from one breast and 1.4kg from the other in the first surgery. The second surgery was a lesser reduction with scar revision. My first reduction was a botch job and my breasts were quite asymmetrical. The surgeon who performed the second reduction said that some of my ducts appeared to be intact, which gave me hope for BF in the future.

I had my first child when I was 26. My attitude was very much 'I'll give it a go and see what happens'. Once I had actually given birth, all those lovely hormones were telling me that I needed to BF my baby. I had a traumatic vaginal delivery; baby in distress, failed ventouse, extensive episiotomy and forceps delivery. My DD1 was full term but only 5lb 10oz with a poor appetite and weak sucking reflex. She was put to the breast in the delivery suite very soon after delivery, but I had a massive PPH and she was handed to my husband. I was unconscious for approximately an hour. I next attempted to BF her when I had been taken to my room, about 4 hours after delivery. I buzzed for a MW to assist me and she came in, took one look at my boobs and said 'oh, hold on, I'll be back'. She returned with a bottle of formula, handed it to me and said 'here, you'll need this'. When I told her I wanted to try to BF she told me there was no point, I wouldn't be able to feed after a reduction. Over the next few days, I received conflicting advice from the MW's; some said I should try to BF, other's told me not to bother as I wouldn't be successful. The few of times in hospital that I tried to attach DD (with the help of a supportive MW) it was very difficult. She was sleepy, jaundiced and not hungry. By the time I was discharged, DD was FF and I was confused. I knew I had some milk as my boobs were hard and sore and milk would dribble down my chest when I undressed for a shower, but I had been told that there was no point trying to BF DD. On and off for the next three weeks or so I tried to attach DD but not with much success. Quite frankly, I had no idea what I was doing! I do not come from a family of BF'ers, my sister FF and my mum did also. Being quite young, most of my friends didn't have kids yet so I didn't have a support base there either. Ultimately, DD was fully FF by the time she was 3 or 4 weeks old.

When I fell pg with DS, I was determined to try harder to establish BF. I educated myself by reading and researching, I now had many friends with children who had successfully BF. I surrounded myself with information and support. I bought the book I mentioned earlier and a SFS. I was determined! I had researched enough to know that I may not be able to exclusively BF, but I wanted to share that lovely relationship with my baby and give him whatever BM I could. We hit a snag when we were told at the 20 week US that DS only had a single kidney and that kidney looked non-functional. We were advised that this was a 'non-viable' pg and that we should consider termination. We never questioned that we wouldn't continue the pg, but you can imagine that it was a terribly stressful few months. I fully expected to give birth to a still baby, or to lose him shortly after delivery. The delivery itself was a very straightforward vaginal delivery. I was induced at 39w 6d as emotionally I couldn't continue any further. I had an epidural and a minor tear. DS surprised us all by coming out chubby and wailing! He was delivered onto my chest and checked by a paed, then put to the breast. He was much stronger than DD and much hungrier. I put DS to the breast at every opportunity. i don't think he was off the breast for the first four days! Several MW's offered me formula, a couple insisted that I needed it. I handed them my copy of BF after reduction and asked them to read it on their break. Most appreciated it and told me that they had learnt something for the book, a couple rolled their eyes at me. By day 5, DS had lost more than 10% of his birth weight. Given his renal problems, we simply couldn't afford to allow him to become dehydrated. His urologist, who knew and supported my desire to BF, told me it was time to comp feed with formula. I started offering formula after the breast. I continued to BF until DS was 12 weeks old, offering first the breast, then formula. At about 12 weeks, DS was ill with an infection and he was hospitalised. I still offered the breast, but he was listless and disinterested. I had to get fluids into him and the only way was with the bottle. That was the end of our BF, although he is now almost 7 and still loves to stick his hand down my top when he's tired!!

When I was pg with DD2, I was again determined to BF. More research, more reading... I knew that I had at least some ducts which were patent, but not enough supply to exclusively BF. The millions of herbs I had taken when BF DS had done nothing more than give me a belly ache! I decided that this time I would try Motilium to establish a supply. I convinced my OB to prescribe Motilium from the time of delivery. Usually, you first need to establish that you have an inadequate supply, but I argued that we had established this through my experience with DS. Again, I surrounded myself with supportive people, including a very good mate who is a MCHN, MW and LC (she also supported me through my experience with DS). DD2 was a straightforward vaginal delivery, a short labour like my other two. She was delivered onto my chest by the MW (so quick that the OB didn't make it!) who said that she literally came out sucking. She was put immediately to the breast where she attached immediately and suckled both sides for about an hour all up. I reminded my OB to prescribe the motilium whilst he was suturing my small tear! DD2 seemed to be made to BF - she knew what to do, attached easily and had a strong suck. Again, I had her on my breast at every opportunity. She lost right on 10% of her birth weight by discharge and we left the hospital exclusively BF. I truly thought that we were headed for a BF relationship without comp feeding, but I was aware that I needed to monitor her weight and her nappies. My girlfriend offered to weigh her at home for me every couple of days. DD continued to lose weight. I couldn't feed her any more. I wore her in a sling and had her on the breast, where she actively suckled, more often than she was off the breast! I was taking 80mg of Motilium per day, eating lactation cookies, drinking litres of water, expressing after every feed... By the time she was 12 days old, her nappies started to become dry and smelly. My GF weighed her that afternoon and she had again lost weight. My GF looked at me, I looked at her... and I cried my eyes out. Dh held me while I sobbed, until a had a big sniff and said 'ok, I know what this means'. I started comp feeding DD, offering formula after a full BF. I was pretty certain that this was headed in the same direction as my experience with DS - a couple of months of persistence perhaps, then we would be at the bottom of that FF slippery slope and BF would be out the window. But DD continued to prefer the breast. I offered her the formula and sometimes she would take a little, sometimes a lot... but other times, she refused the formula and was satisfied by a BF. The difference was that the BF she clearly enjoyed, whereas the bottle was purely business for her. We continued this way until I introduced solids at six months. She is a great eater and she would have a BF, eat some solids then refuse the formula but nuzzle into my chest for another BF. By the time she was about 7 months, I offered Miss P a bottle after the BF in the morning and one after the last BF of the day. Sometimes she would take it, other times she would refuse. She has never, not once, refused the breast. So, now she is 19 months old and we are still going strong. I still pretty much BF on demand, although I will distract her if it entirely inconvenient - something I would do by this age regardless of our feeding history. I would be satisfied if DD decided to wean now, but she is a boobie monster who loves to snuggle into mummy for a feed. We have always co-slept and overnight is Open Bar, I sleep with my top open and she helps herself. My mother encouraged me to wean when DD was 6 months (yep, right when we finally found our happy groove!) but I keep threatening to feed Miss P until she's 20!

So, what was different this time around?

I was educated, determined and not distracted by other concerns (such as DS's renal issues)

DD2 went straight to the breast after delivery. I had her on my breast at every single opportunity in those first few weeks to try to establish a supply. I also expressed after each feed, working on the supply=demand theory.

The Motilium made a huge difference to my supply. I weaned myself onto a lower dose at about 4 months and saw a huge drop in supply. I eventually stopped taking it altogether when DD was about 10 months old and eating a full and varied diet. I didn't see much drop in my supply at that time, I think because it had been established for so long.

I surrounded myself with supportive people. This included my DH. First time around, we were both new to this parenting business and had no idea what we were doing. Second time, we were stressed out of our minds with concern for DS's health. This time, I discussed at length with DH how important it was for me to give my all to BF and he offered his absolute support, both emotional and practical.

It has been shown that women who have had a reduction have greater success with each subsequent baby that they BF. This (according to my reading) is because the ducts recanalise with each BF experience. This was my third attempt.

DD was the perfect BF baby - she just knew what to do! She was strong, with a good sucking reflex. She loves to BF and has from the moment she was born. DD1 was small and had a poor suck reflex, DS was a bit lazy!

Oh, I tried the SFS with DS. It didn't work for us. It's very fiddly and quite difficult to get in the right position, then DS would spit the straw out as soon as I got him attached and the straw in his gob. I stuck with it for a few weeks... then I threw it out in frustration!

Long post, sorry! I hope my experience gives you some encouragement - you can BF after a reduction. And you can keep feeding until your baby is 20! :)

Nickle, thank you very much for an amazing, well-written reply, and such an interesting history. One thing that definitely comes out of your story is the difference it made having a fully supportive husband and carers (including your LC friend.) On top of that, your determination and perseverance are totally inspiring. I think you should be incredibly proud of the effort you put into BF all three of you lottle ones, and not just the 3rd, with whom you feel you were finally successful.

I think I will try to make contact with the hospital LC in the next month or so, and make sure I already have an established rapport with her from the start. And if we clash, or I don't find she is as positive and supportive as I would hope, I will have time to find a private LC who perhaps can visit me in the first 24 hours after birth to get us started. And it hadn't occurred to me that potentially motilium could be used from the very early days. I think I will speak to my obs about this, even if I don't have an established history of low supply.

Wow! Thank you again for such a detailed and generous response. It seems Iike it took courage and persistence, so I'll be aware of that now too. I'm getting up to 5 drops of colostrum each side now and getting familiar with the ducts etc.
I am inspired by Pholi and Nickle... Thank- you both! U might get sown urgent messages in October after our little girl is born!
Xo

It ended up being a very long response, FL! I think persistence is a big key, and being able to move forward when you face a disappointing setback - whether it's a supply issue, cracked nipples or unsupportive MW's. And the support of your partner is paramount, because he needs to understand why it is so important to you to continue when so may people will tell you not to bother (particularly if you do need to comp feed).

FL, I see you're in Melbourne. Which hospital are you having your DD at?

FL, I have tried to accept your friend request, but it doesn't seem to be working?? Will try again!

Hi Nickle,
We are booked to birth at Monash Clayton in the birthing centre :-) we now have a Doula who is fab so she has given us a lactation consultant recommendation.
Thanks again :-)

Well, FWIW, the boob that had surgery is currently producing about twice that of the other boob. So it can be done :).