Have you had breast surgery and know you're concerned about whether you'll be able to breastfeed? Good news is you may be able to. Here's what you want to know.
Breastfeeding after breast reduction or enlargement surgery is certainly possible, but it can affect lactation. Generally speaking, implants have very little effect on breastfeeding while reductions can throw a real spanner in the works. But there’s really no way to tell until you try.
Johannesburg plastic surgeon, Dr Gareth Edwards, puts it this way, “Predicting who will be able to breastfeed after breast surgery is a bit like predicting who will be able to play the piano after surgery. It all depends on whether you were able to do it before.”
So, if you were able to breastfeed before surgery, chances are you’ll be able to do it again after, especially if you had implants rather than reduction surgery and if you wait a while before falling pregnant.
Talk to your doctor
The best thing to do if you’re having breast enlargement or reduction surgery and are hoping to breastfeed afterwards, is to discuss this with your doctor. There are different options for performing both types of surgery, so if your surgeon knows that that you still wish to breastfeed, they will ensure that as much of the breast tissue as possible is kept intact.
“With breast augmentations, there’s rarely a problem because implants are usually inserted under the chest muscle and the breast tissue is hardly disturbed. Just make sure that your doctor makes the incision under your armpit or under the breast rather than at the areola,” says Dr Edwards.
“But breast reduction surgery is another matter. Some surgical techniques preserve more lactation tissue and critical nerves than others. In order for a woman to be able to breastfeed after reduction surgery, it’s important that the areola and nipples are not completely severed, even though they may be moved.”
Don’t assume that your nipples were severed if you have a scar around the outside of your areola. All types of breast reduction surgery leave a scar around the areola, plus the trademark upside-down T-scar.
Dr Edwards explains, “Most current breast reduction surgical techniques involve moving the areola and nipple while still attached to a wedge of tissue, called a pedicle, which contains enough lactation tissue and remains attached to the ducts and primary nerves.”
There are breast reduction techniques that completely sever the areola and nipple from the breast. This type of surgery will seriously limit your chances of breastfeeding, but these days doctors only perform this kind of surgery on women whose breasts are so large that the pedicle technique won’t work.
Every mom will have a different experience
"In theory, I should at least have produced some milk"
Doctors say it’s very difficult to predict what will happen. Every mother is bound to have a different experience. Some will be able to breastfeed exclusively, others may need to supplement and a few more won’t be able to breastfeed at all.
Ziska Baumgarten says, “I had my size 36DD boobs reduced to a 36C almost 10 years before my first pregnancy. I knew all along I wanted children and told my surgeon of these dreams and my wish to breastfeed and as far as I know my nipples weren’t completely severed during surgery. In theory, I should at least have produced some milk. But I didn’t. The most I was ever able to express was a drop or two.
“I really wanted to breastfeed my son and did everything I could. I put Seth to the breast as soon as I could after he was born by emergency caesarean. A nurse helped me to get him to latch and he suckled for a while, but soon became disinterested. This happened every time I put him to my breast.
"I got quite despondent, but didn’t want to give up. So I called in a lactation specialist. After examining my breasts and trying to manually express some milk, she told me that I’d probably not be able to breastfeed.
"But I refused to give up. I tried all sorts of things, including several teas and potions to increase milk production. But my milk never came in. After 4 or 5 days, I gave up and started to bottlefeed my baby. By this time he was starving and I felt like a failure as a mother. I blamed myself for having had the surgery, because I couldn’t do what comes naturally to all women.”
"Even a little bit of breastmilk helps"
Not all women who’ve had breast surgery battle to breastfeed. Linda Kohler had a bilateral breast reduction when she was very young (19) and only had her first child at 37. “What I did with both my children was to breastfeed for 10 or 15 minutes and then my husband would do a supplementary bottle feed.
"I breastfed my first child for about 4 months and the second for 3 months. It was important to me to breastfeed, even if they got very little milk because I believe that even a little bit of breastmilk helps their immune system.
"It was also important for me for bonding and what I’ve noticed is that my two children have no parent preference. They don’t insist that I take care of them when they’re ill or upset, they're equally happy with my husband there.”
The healing power of time
The mammary system is made up of many cooperative, redundant networks of glands and ducts. Even with the most invasive surgeries, it’s possible that some of the glands and ducts damaged by the surgery will reconnect – a process known as “recanalisation”. And it’s possible some of the nerves critical to lactation may regrow – a process known as “reinnervation”. The body is remarkably resilient.
Almost all women who have breast reduction surgery will be able to lactate to some degree. But if a large portion of your lactation system was damaged by the surgery, you may not have enough milk for your baby and you may have to supplement.
The length of time between your surgery and pregnancy is also important. Research has shown that women have a better milk supply when the surgery was done 5 or more years before pregnancy. This is probably the result of recanalisation and reinnervation and also because of the hormonal influences of each menstrual cycle which encourages the development of your mammary glands.
The longer the time lapse between your surgery and your pregnancy, the more time your boobs have to redevelop their mammary tissue.
Breast care after surgery
After implants or a lift, your breasts will be tender and feel tight. After reduction surgery, though, your chest area will be very sore and lifting anything heavier than a cup of tea will be extremely painful for the first week or so. Your nipple sensation may be reduced, but should return after a few weeks. There will also be some swelling and bruising, which will eventually disappear.
There are things you can do to aid your recovery after surgery:
- The most important is to wear a gentle bra over the gauze dressings. Something like a cotton feeding bra (definitely no underwires) is the best. The support bra stabilises your breast tissue, increasing your comfort.
- Your doctor will prescribe pain medication to ease your recovery, but contact him if the pain is unusually severe or if you notice any fresh bleeding.
- Healing is a gradual process. Most patients are up and about the day of surgery, but do not plan on returning to work for a week or more, depending on the extent of your surgery and how you feel.
- Avoid lifting anything over your head for 3 or 4 weeks.
- You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month.
Were you able to breastfeed after a reduction? Send us your story!
We need to hear your story! Websites like www.bfar.org are full of anecdotal evidence that it is possible to successfully breastfeed after surgery – even reduction surgery. However, we were not able to find a mother who had breast reduction surgery and was able to breastfeed exclusively. If you were able to, we would love to hear from you. Please send your story to firstname.lastname@example.org.
- Dr Gareth Edwards, Netcare Breast Care Centre of Excellence: 0860 233 233, www.breasthealth.co.za
- Lactation specialist, Sister Barbara Constantinou: 011 455 5468
- La Leche League South Africa: 011 475 5837 or 021 689 9308, www.lllsa.co.za