I have an acquaintance who has become sort of a client. She is 32 weeks
pregnant and was diagnosed with breast cancer two months ago. She had one
breast removed 8 weeks ago, and will be starting her second round of
chemotherapy this week. She will then take a 4 week break from chemo, before
delivering her baby by c/s at 36 weeks. Two weeks after that she will begin
the first of many more rounds of chemo. On advice of her perinatalogist and
oncologist, she has decided that she will not breastfeed at all.
I would like to give her some anticipatory guidance as to what will happen
in the hospital and early days regarding her milk.

She has older children that she breastfed without problem for a long time,
so I am thinking that there is a likelihood that she will experience an
early and robust milk surge.

My question is for those who work in hospitals - what kind of care for
engorgement and reducing milk supply is likely to receive? What are the
range of options she is likely to be offered, and what strategies could she
request. Her chest is still very sore from the surgery. Pardon my ignorance,
but will she be given medication to dry up her milk, or is that completely a
thing of the past?

Her oncologist is very concerned that any infection would slow down the
chemo schedule, so it is important to avoid even an inkling of mastitis.

Is it likely that she will get any engorgement on this side with the
mastectomy? I imagine that they try to get all the breast tissue but could
there be some remaining? I do not have the details of the surgery, but I do
know that in discussion with the doctors she was adamant that preservation
of tissue for reconstruction was unimportant.

Sorry for such basic questions. I am relatively new and work in private
practice - this is entirely outside my realm of experience!

Thank you,

Molly Brannigan, IBCLC

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