As a Lactation Consultant, I get this question a lot. Soon to be moms want to know if breastfeeding will be possible for them if they have had breast surgery in the past. This is a tricky question to answer, I say possibly but it can be challenging.
The likelihood of success can depend on several factors, such as where is the incision, when you had the surgery and why you had the surgery. The main problem is there is no way of knowing for sure there is a problem with milk supply until you have had your baby!
Breastfeeding is a learned skill for both mom and babe and you are expected to learn this skill during a difficult time when you are exhausted after the marathon of labour and delivery! It can be a steep learning curve, so I always tell you soon to be parents that the more information you can gather and learn ahead of time the better the position you will be in when you try to master this skill! This is especially important if you can anticipate you may have some struggles with breastfeeding. Breastfeeding is a supply and demand system, so if you anticipate challenges you will want to be as prepared as possible as there is less room for error right out of the gates. If there is a bad latch or feeds are not frequent enough you won’t produce as much milk and if this is combined with an already lower than normal milk supply it is going to be a problem.
Where is the incision?
Whether you have had a breast reduction or augmentation my first question would be where is your incision? The location is the incision and which technique used plays an important role in determining the likelihood of breastfeeding success. If nerve pathways and blood supply are left intact then there is a much greater chance for breastfeeding success.
Breast reduction surgery
The most common and preferred technique for women of childbearing age is called the inferior pedicle technique. With this surgery, there will be 3 incisions one around the areola, one vertical down the middle of the breast and a horizontal incision across the bottom of the breast. The incision will look like an inverted “T”. A wedge of excess breast tissue is removed and the nipple and areola are shifted to a new higher position. The breast tissue removed is not just fatty tissue but also glandular tissue. Glandular breast tissue contains lobes, where milk is produced and ducts, how milk travels towards the nipple.
The vertical scar technique is similar but there will be just 2 incisions. One incision around the areola and the other vertical down the middle of the breast, the incision looks like a lollipop. Some breast tissue is removed and the breasts are reshaped to a smaller size. The nipple and areola can be repositioned higher.
As you can see, women who have had a breast reduction may struggle with maintaining an adequate milk supply as they have lost some of the important milk-producing breast tissue, but these surgical techniques are associated with higher lactation success rates because the nerves, blood supply, and ducts in the areola to the nipple are left intact.
The free-nipple graft technique removes the nipple and areola completely as well as additional breast tissue. The nipple and areola are then reattached. Less scarring with this technique but there would be a loss of nipple sensation and breastfeeding success would be unlikely as blood supply to the nipple was severed and nerves were damaged.
There is also a liposuction-only technique. Success will depend on how much breast tissue was removed.
Breast tissue can regrow and nerves can regenerate! Is there a sensation to the nipples? If there is this is a good sign that the nerve supply is intact. Nerves responsible for sensation are required for the letdown reflex, which is the signal to your brain to produce milk.
How long has it been since your surgery? Breastfeeding will be more successful if it has been 5 or more years since a breast reduction surgery. And interestingly, milk supply will increase with second and future pregnancies!
What can I do to prepare?
Here are some ideas of things you can do that will help give yourself the best chances of building a solid milk supply.
- Get a hospital-grade breast pump. Mom’s who have had breast surgery will need a good quality breast pump as they will have some pumping to do to establish the best milk supply possible.
- Antenatal hand expression can be really useful for establishing milk supply before the baby comes! If you would like more information on this read the article, here.
- Plan on lots of skin to skin when the baby is born. More information on why this is helpful you can find here.
- Research breastfeeding clinics and support groups near you, so if you need help you know where to find it.
- Be prepared to supplement with either formula or expressed breast milk. Supplemental nursing systems can be a really useful tool, wondering what is this all about check out this article, here.
- Consider milk production agents such as the herbs-fenugreek and blessed thistle and the prescription medication Domperidone.
Breast augmentation surgery
Women can usually breastfeed just fine after having breast implant surgery as the surgery doesn’t usually involve ducts or areas of the breast involved in milk production.
The inframammary technique is the most popular and would be the preferred technique in childbearing aged women as the incision is horizontal in the crease under the breast and the implant is often placed behind the chest wall muscle.
If the incision is made around the areola or in the armpit then it can affect nerves and interfere with sensation. If nerves are severed then your milk supply will most definitely be affected.
Why did you have the surgery?
If they describe their breasts as being undeveloped, flat, tubular, or asymmetrical then they are at risk for low milk supply as there may have never been enough glandular tissue. They can experience difficulty producing milk and supporting an adequate milk supply which has nothing to do with the implants. Implants can lead to other lactation-related issues such as engorgement (very full breasts) and mastitis (breast infection).
If you are expecting and have undergone breast surgery you are more likely to encounter challenges but the odds are in your favour. Reach out to a Mama Coach in your area for lactation support to find success with breastfeeding after breast surgery.