In my experience, moms with reductions have the following issues:
1. scar tissue and reduction of elasticity in the nipple areolar complex
that reduces the efficiency of pumping and sometimes makes feeding painful.
2. reduction in nipple sensitivity (or hypersensitivity) that negatively
impacts MER or breastfeeding comfort.
3. reduction in milk making capacity from the removal of glandular
tissue and the disruption of ducts and drainage of the breast.

None of the moms I have worked with have made full supplies, though some
have come close, including one mom who had a free nipple graft 23 years
previous to her baby's birth.  I prefer the Lact-aid to the SNS in this
population, it seems to make the baby work more which optimizes the
supply.  Galactogogues are also helpful, particularly domperidone and
the herbal galactogogues (fenugreek, blessed thistle, goat's rue).  The
Whittlestone pump might be more effective for moms with scar tissue
because it is gentler, though it is not that effective under normal
circumstances.

In short, I would encourage moms with previous reductions to breastfeed,
but would educate them that they might not have a full supply of milk,
and should line up a lactation consultant before they give birth.

--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html