Esther,
       I have worked with a number of mothers who have breastfed after having
a breast removed due to breast cancer.  There are some things I have learned
to explain to these moms before they ask.  I explain to them is that a painful
nipple is not normal.  You need to explain this early.  I have learned that
these moms don't mention the pain, because they think it is inevitable, since
they are "using one breast twice as often."  Even mothers who have already
breastfed a previous baby uneventfully still think this will be the case.
Usually, I remind them that the previous baby breastfed very frequently during growth
spurts, yet mom did not get sore.  I ask them to call me if they experience
pain, because pain indicates baby is not nursing correctly.
       Another thing these moms tend to think is that they will need to
supplement at least the first two or three weeks because their remaining breast
will take a while to build up twice as much milk.  Again, I have learned to bring
this up myself, and remind them that mothers of twins have enough milk for
two babies in just a few days (usually).  As I point out that this comes out to
one baby per breast, they realize that they are also feeding one baby on one
breast.  So I ask them to let me know if they do not seem to have sufficient
milk once the milk comes in.
       Mom R had augmentation of the healthy breast.  Depending on what
nerves and ducts may have been damaged during the surgery, this mother may or may
not experience any supply problems.  If she does, some of the same suggestions
for mothers who have experienced reduction surgery may be helpful to her.
       Mom D's situation is more complex.  She could breastfeed on the
healthy breast and allow the treated breast to dry up.  Some mothers do breastfeed
on a breast that has previously experienced lumpectomy and radiation.  In cases
of breast surgery, we know that in many cases, the longer it has been since
the surgery has been done, the better the chances that nerves will regenerate
and ducts will recanalize, so that breastfeeding might proceed unharmed.  With
radiation, the opposite seems to be true.  Doctors are finding that the longer
ago the breast was irradiated, the worse her chances of breastfeeding seem to
become.  At this point, no one is sure why, but there is some conjection that
the burning of the radiation continues to cause more scar tissue to form as
time goes by.  And radiation affects the entire breast, not just the local area
a surgery would be performed in.
       Of those women who attempt to breastfeed on a previously irradiated
breast, many experience pain in the breast.  Some find the pain tolerable, and
some find it extreme.  Some experience the pain only in the first few weeks of
breastfeeding, and gradually the pain goes away.  Others have the pain
throughout the breastfeeding experience.
       I have also worked with mothers who have experienced a lumpectomy for
biopsy, but were negative for cancer so did not need radiation.  Many times,
these mothers experience repeated plugged ducts and mastitis in the area behind
the surgery.  Some prefer to dry up that breast, but others have put up with
the recurrent mastitis because they wanted to continue to breastfeed on both
breasts to help reduce their chances of breast cancer in both breasts.  I find
the mothers who are upset about recurrent mastitis are the ones who don't know
why they have this problem.  Those who know why and make the choice to
tolerate the situation are OK about it.
       I explain these different outcome possibilities to mothers who ask me
about breastfeeding after radiation.  I feel that by knowing the
possibilities, they can make a more informed choice about whether or not they want to
attempt it, and then they won't be so surprised at whatever happens.
       Hope this helps.
       Dee

Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA

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