Hi Brenda,

I have found it helpful to discuss the mother's goals first so that I
get a better
sense of what kind and how much informaiton to offer.  I work in a
hospital and
usually know from the chart that the surgery has occured.  It might even
be the
specific reason for the consult.

After I introduce myself and admire the baby and learn the baby's name,
I will say
something like "Your doctor has asked me to see you because of your
history of
breast reduction surgery.  Since there can be as many different outcomes for
breastfeeding after reduction as there are mothers, can you tell me a
little more
about the surgery?"  This usually gives me a better indication of how
old she was,
what the surgeon might have told her, where the scarring is, etc. 
Anything that
she shares that is positive gets affirmation, e.g. nipple sensitivity, breast
changes during pregnancy, etc.

Then I will ask her what she hopes to accomplish and what part of
breastfeeding she
is most looking forward to.  If it is the bonding, then I will focus
more on how
that can be accomplished despite how much milk she produces, leading to discussions
of supplementing, wearing the baby, galactogogues,etc.  If it is the
benefits of
breastmilk, we'll discuss many of the same points but from the
perspective of how
they enhance getting the maximum amount of her breastmilk to the baby. 
You have
mentioned some excellent points in your post that mothers who have had reduction
surgery will want to know at some point in the discussion.

I *always* refer to Diana West's BFAR website.   Encouraging the mother
to talk to
those who have done what she wants to do lets her know she is not alone
or crazy
and I stress that they will know many more ways to approach it than we
can discuss
in the limited time we have together.

This is a very brief description of the conversation.  I hope it is
helpful to you.

Cindy Garrison BS IBCLC

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