*breastfeeding after breast surgery

        Hi. My name is Charla and I'm a junior nursing student at UND. I've always supported breastfeeding and have often wondered how breast surgery, breast reduction and breast augmentation affects a women's ability to successfully breastfeed. Most of the literature I found on this topic was from the early 1990's, with the most recent being from 1999.
        The information that I found was consistent regarding both breast reduction and breast augmentation. It supported the idea that minimal disruption of lactiferous ducts and innervation is essential for preserving the potential for future lactation (Hughes, & Owen, 1993). Studies have shown that women who have undergone breast augmentation have higher success rates when compared to those who've had a reduction.  Hughes & Owen (1993) conducted an interview with 51 women who had breast reduction or augmentation done.  The results showed that of the 23 women who underwent reduction, only 30% were successful in breastfeeding as long as they wanted, as compared to 62% of those who had augmentation. This is believed to be due to the location of the incision. As Mohrbacher, et. al. (1997) stated, if the mother's incisions are in the folds under the breast or near the armpits, the implants were most likely inserted behind the milk ducts, leaving them undisturbed. Generally spe
aking, if the milk ducts and major nerves have not been cut, there should be no complication or difficulties with breastfeeding. If the women's incisions are around the areola, it's likely that some of the milk ducts have been severed, thus leaving the women with a 5 times higher likelihood of having lactation insufficiency (Hughes & Owen, 1993).
        Women who are considering breast surgery and are concerned with the effects on breastfeeding should discuss various techniques used and ways of preserving the ducts and blood supply to the areola with their surgeon.  In addition, women need to be aware of the risks and complications that breast reduction and augmentation pose.  Whenever surgery is performed on the breast, loss of sensation is common.  Typically, most of the feeling comes back to the breasts within 6mo-2yrs after surgery.  Some women experience unusual sensations or extra sensitivity after breast surgery.  Usually, the more extensive the surgery, the greater the loss of sensation.  The nerve stimulation of the baby's suck is what sends the signals to the brain to initiate milk production, so as long as the areola has some feeling, breastfeeding should not be affected (Mohrbacher, et. al., 1997).  There are also reported cases of severe postpartum engorgement resulting in pressure atrophy. Milk product
ion continues only in those portions of the breast with intact drainage systems (Riordan & Auerbach, 1999). Since the severed ducts cannot empty, pressure builds up, leading to atrophy.
        The only sure way to know if a woman will be able to breastfeed following any type of breast surgery is to try it and see what happens.  As Hughes & Owen (1993) report, the women they interviewed encourage similar mothers to give breastfeeding a try but allow themselves room to change their mind. The women recommended that women become as informed as possible, seek help early, and be patient and persistent.
        The articles that I have read pertaining to this topic have given me enough consistent information where I feel comfortable answering questions from friends, family, and clients. After reading the literature, I feel reassured that women who choose to have breast surgery will still be able to breastfeed to some extent.
        I'm curious as to what type of breast procedures that some of your clients have had, and if it's impacted their ability to breastfeed. A new area of breast surgery that has caught my eye recently is breast augmentation using your own tissues. Has anyone seen this in their practice? If so, how did the women tolerate breastfeeding? If anyone has any information or comments about this topic, I would very much welcome them.

Thanks in advance,
Charla Nevalainen, UND nursing student


        Hughes, V. & Owen, J. (1993).  Is breast-feeding possible after breast surgery? MCN: American Journal of Maternal/Child Nursing, 18, 213-217.

        Mohrbacher, N. & Stock, J. (1997). The breastfeeding answer book. Schaumburg, IL: La Leche League International.

        Riordan, J. & Auerbach, K. (1999). Breastfeeding and human lactation. (2nd ed.). Boston: Jones & Bartlett Publishers.

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