Janet Simpson:
RE:  Breast reduction and subsequent BF:  It is encouraging that
you state woman has had breast changes during pg.  This is a good
sign.  Often with reduction surgery most of tissue removed is
fatty tissue and not mammary gland.  However, depending on the
type of surgery - suction, etc. as well as the care of the
physcian doing the surgery, some mammary gland tissue may be
affected, damaged and/or removed.  Another possible problem is if
the incision damaged any nerves necessary for the conduction of
messages to the hormone centers.  This is really variable between
women.  If the nipple was moved, chances are nerves were severed.
The only way to find out is to have the mom start BF and
see what happens.  This woman would be at higher risk for
problems, so she and baby should be assessed often in the
beginning for signs of milk - MER, swallowing patterns in baby,
weight gain of baby, fullness of breasts, etc. etc.  She may have
one side more affected than another, but could still successfully
BF, concentrating efforts and time on the more productive breast.
If the surgeon did not consider future BF and was "agressive" in
the reduction, resulting in damaging large amounts of mammary
gland tissue, the woman would have difficulty establishing a milk
supply.  If only the nerves were affected, she could have initial
engorgement/milk supply but be unable to maintain the supply.
Therefore, she and baby should be monitored closely for the first
4-6 weeks to make sure that not only the immediate pp hormones
kick in, and also that the nerves work to send hormonal messages
so that the milk supply continues to be established and increased
to meet baby's needs.  Hope this helps.  Theresa Gutsch, MS, RD,
CL