I had an interesting case last year on this note. I had a primip mom deliver a term infant, was taught BF in the hospital, was well educated, had read a lot, etc. She called me on about day 5, reporting insufficient output from the infant , despite very adequate nursing times, good latch, etc. I knew that she had had bilateral breast implants, but no duct severage or nipple involvement. I saw her and baby, and put her on a pump. She got almost nothing, and reported no leaking, breast changes, nothing. During further questioning, I asked her just how small her breasts were prior to the implant surgery. She said she had NONE, and that her father used to joke that he couldn't tell whether she was coming or going (!). I had the sad job of telling this mom who really wanted to breastfeed that she was not likely to ever develop a real milk supply due to lack of glandular tissue. I wish that her surgeon had given her more information other than telling her she could probably BF! As it turned out, I told her she could certainly still continue to put the baby to breast for the mom/baby bonding part that she liked, and use an SNS if she wished. She did do some "comfort" nursing, and chose to formula feed, and baby did well. What it taught me was not to assume that the history relayed to us is always complete! Denise Mollenkopf, RNC, IBCLC [log in to unmask]