A mother called me a couple of months ago to get my opinion of the
possibility of her breastfeeding her baby after having had breast reduction
surgery 14 years ago when she was 16. She described scars under her breasts
and said that both areolas with nipple were removed and moved to another
place on her breasts.

I told her that I didn't know, but that I had worked with another mother who
had had extensive surgery to create everted nipples from inverted ones and
who had successfully lactated. I advised her to plan to breastfeed her baby.

She delivered last week and immediately was able to express colostrom. The
baby fed well, though her nipples were sore because, since the surgery, they
have been extremely sensitive to the slightest touch. Baby was audibly
swallowing. Her mature milk came in on day 4 and she was leaking from the
side the baby wasn't feeding on. The sensitivity is lessening.

She was so thrilled to see milk coming from her breasts.  So was I!  Isn't
that truly miraculous?  Her breasts look like a real butcher job--big scars
from "3 oclock to 9 oclock" The areolas looked glued on.  She had had much
breast pain all through the years until a few years ago when she had some
deep tissue body work to free some of the adhesions. I am assuming that with
each menstrual period she had since she was 16, more milk-producing capacity
was developed, and ducts were even re-routed to her nipples! Amazing!

Her supply seemed below what her baby wanted so she began pumping.  Dad had
been around while I was working with her (I do home visits) and he was very
detatched and disinterested.  When she began pumping, a few ducts were
spraying and she was getting a pretty good flow.  She was so excited. Then
Dad looked over and said, "All you need to do is Moo."  She gave an
embarrassed laugh and I commented that she is making human milk for their
baby and doing a great job.  He said that he grew up on a dairy farm and the
pump sounded just like the pump for the cows 'cept they had four instead of
two.

Immediately the milk flow stopped.  Not a drop would come. She suggested
that I turn up the marker to med or high. I turned it gradually to
med--still no milk. I suggested that she try later because perhaps her baby
took most of the readily-available milk.

As we were clearing the pump area it came to me what had happened.  I had
been so focused on the mother that I hadn't put it together at first. So
while she went to change the baby I had a "talk" with Papa.

I let him know that she needs him to be her cheer leader and to share in her
joy that her body has healed to the place that she can make this great milk
for their baby. I didn't mention what had just happened, but I made it clear
that he has a responsibility in the health of their baby and that
breastfeeding is "where it's at."

When she returned he expressed enthusiasm for the diaper report and seemed
to have become an alive person.  He listened with interest to my
recommendations.

I left her some fenugreek capsules and the next morning she called to say
that baby was swallowing much more--gulping even--and she was pumping a lot
more.

I've thought about her experience with her body--from rejection, poorly-done
surgery, pain, healing body work, her breasts recovering from it all, her
husband's derisive remarks, the stopped flow, his new encouragement matching
her determination (even with sensitive nipples), and now she can have the
joy of watching her baby girl grow on her milk.

Wow!

I predict that she will make a full milk supply. Almost everyone told her
that she would either not make milk or, if she did, it wouldn't be able to
get out.  After she was seeing  milk, people were saying that she would
probably not be able to make enough. I told her to forget that she had had
surgery (and to stop listening to people) and just look at all of that milk
dripping all over her shirt!

There is a lot in this story to ponder.  How often is a milk supply affected
by expectation--either of mother or others?  Fathers need to learn what they
can do to really help. Encouragement or discouragement can do so much.
Severed milk ducts can be overcome if the fear of severed milk ducts can be
overcome. If she hadn't had the healing body work would she have been able
to do what she has?

Someday I'm going to write a poem for all of the heroic women I have worked
with these many years.

Patricia Gima, IBCLC
Milwaukee, where we had a "lovely" Easter snow! "In your Easter parka..."
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