Effects of Breast Surgery on breastfeeding

Possible Effects of Breast Surgery on Breastfeeding Success

It is important to ask the mother if she has ever had any type of breast surgery or surgery around the area of the breasts. Breast surgery can adversely affect the ability to nurse by interfering with normal anatomy and neurohormonal pathways.

Lumpectomy: Procedures to remove breast lumps can affect the lobe where the lump was removed. Following lactogenesis, the mother may notice a hard, painful area in the quadrant of the breast near the incision. One or more of the ducts may have been severed during the surgery especially if the lump was near the areola. The area will eventually reabsorb and involute with no effect upon total milk supply unless a large portion of the lactating tissue is involved. Since lumpectomy is unilateral in most cases, the mother will produce sufficient milk from the remaining tissue.

Augmentation: Following breast augmentation surgery (breast implants) there is about a 50-50 chance that the woman will be able to breastfeed. It is important to ask questions about the shape and size of her breast(s) before the surgery. Asking about her reason for the implant surgery may reveal an undiagnosed case of Insufficient Glandular Development, especially if the augmentation was unilateral.
It is important to note the location of the surgical scars. If the implants were inserted under the breast the scar will follow the curvature of the underside of the breast. Ask the mother if she experienced any permanent loss of nipple sensation or an increase in nipple sensitivity following the surgery. If so, the nerve supply to the nipple may have been interrupted and let-down may not occur. If the implants were inserted through the areola, the scar will appear as a half moon shape on the lower edge of the areola. With this type of implant surgery, the nerves and the ducts may have been severed, trapping the milk within the breasts. If the ducts were severed, the mother will experience severe engorgement and the infant will rapidly become dehydrated and malnourished.

Reduction Mammoplasty: Breast reduction surgery will adversely affect the ability to nurse. Nine percent of all reduction mammoplasty surgeries are done in women under the age of 18 (Fodor 11). Upon visual examination the surgical scar will appear around the circumference of the areola or will appear as an upside down "T." In reduction mammoplasty, the nipples are usually removed and set aside while the surgeon removes the "excess" breast tissue. Both the stroma and the lactating tissue are removed during the surgery. The skin is then tightened and the nipples are centered in the reshaped breast and sutured into place. In most of these cases, the entire ductular system has been severed. On occasion, I have met women with a semi-intact breast structure who could produce small to moderate amounts of breastmilk. Rarely have I seen a woman with breast reduction surgery develop a full milk supply.

NBC News in Los Angeles reported on 5/20/99 that one manufacturer of breast implants has begun full page ads for implants in women's magazines. The full page ad was followed by a quarter page of extra fine print detailing the hazards associated with implants. In the same story, NBC also reported that breast implant surgery and breast lifts are at an all-time high. The major tragedy in breast augmentation or reduction surgery is that the woman may be totally unaware that the surgery could affect her ability to breastfeed. It has been my unfortunate experience to inform the mother regarding her inability to breastfeed in the manner she had planned following such surgery. A feeding tube device can easily supplement the baby at the breast.

It is best if women with implants or reduction surgery are referred to a lactation consultant before delivery to prevent problems. The baby should be followed closely for appropriate weight gain for several weeks after birth. Inform the mother that she should be report any suspicions of low milk supply to the lactation consultant or her medical provider immediately. With the proper assistance and follow-up, breast augmentation or reduction surgery is not a contraindication to breastfeeding. It is impossible to predict who will and will not have a complete milk supply simply from examination. The mother should be encouraged to breastfeed and "see what happens."

[References]

[index]