Breast Reduction and Breastfeeding

Can I breastfeed if I have had a breast reduction?

There are many reasons women have breast surgery, and cosmetic concerns are by far the most common. However, there are some risk factors, such as obesity, diabetes, hypothyroidism, or PCOS, which need to be considered when a woman has had breast reduction surgery and later wants to breastfeed. Make sure you discuss your health history with your lactation consultant so that she can help you make a feeding plan that will best meet the needs of you and your baby.

The likelihood of you being able to exclusively breastfeed depends on the surgical technique used, the amount of glandular tissue removed, and the resultant integrity of blood supply and nerve pathways.

The pedicle technique leaves the nipple and areola attached to the breast gland on a stalk of tissue. A wedge is removed from the undersides of the breast; for the most part, the breast tissue, blood supply, and some nerves remain intact, and breastfeeding will have varying degrees of success.

The free nipple technique removes the nipple areola entirely. The blood supply to the nipple areola is severed and nerve damage occurs.

The amount of breast tissue removed does not appear to affect breastfeeding. The most important factors that do affect breastfeeding are the integrity of the nerves and of the milk ducts. Incisions around the areola are more likely to cause nerve damage and severed milk ducts than incisions in the fold under the breast or in the armpit.

If your breast surgery involved removing some of the milk making glands, this will likely affect the volume of milk you can produce. Milk ducts are more likely to be cut when surgical incisions are made around the areola or into the body of the breast, rather than incisions made in the fold under the breast or in armpit. Milk ducts do regrow, and the rate of regrowth is faster during pregnancy and breastfeeding. This means that you can possibly produce more milk with subsequent pregnancies.

Nerves can regenerate over time, at about 1 mm per month. The more time has passed since your surgery, the more sensitive your breasts and nipples are likely to become, which increases your likelihood of producing enough breast milk. The amount of sensation in your breast will be an important indicator of the amount of nerve damage sustained. If you can feel both touch and temperature on your areola and nipple, you are more likely to experience normal milk ejection during breastfeeding.

Tips for breastfeeding after breast reduction surgery:

• Breastfeed early and frequently.
• Apply pressure to the breasts during breastfeeding using breast compressions.
• Monitor baby closely for signs of adequate intake: 8 to 12 or more feeds per day, adequate wet and dirty diapers, and weight gain.
• Be prepared to supplement after breastfeeding if your baby is not getting enough from the breasts.
• Discuss alternative methods of supplementing your baby with your lactation consultant. You may want to use an at-breast feeder, which allows the baby to feed at the breast while receiving supplement at the same time.
• Pump after breastfeeding to remove more milk. After a normal feeding, the breast will still have about 30% available milk in it. When you pump after a feeding, you can remove even more milk, leaving the breast with only 5 to 10% of available milk. This will trigger the breasts to increase milk production.  
• Use breast massage during pumping and hand express after pumping.
• Pump for 20 to 30 minutes, or until 2 minutes after the last drop of milk. 
• Use mental imagery.
• If your baby doesn’t need supplements within the first 5 or 6 weeks, chances are supplements won’t be needed.
• Refer to www.bfar.org for more information and further resources.