Wanted to add some info to this subject  - It is of interest to me in that I
did my Master's thesis on the effect of breast surgery on lactation. There
are two procedures used for breast reduction surgery: Nipple transposition
and free nipple transplants, with the latter being the less desirable of the
two when lactation is to be preserved. It involves complete resection of the
nipple - removal of the breast tissue - and then reattaching the nipple.
Although most women will not know the name of the procedure - they usually
can tell you if the nipple was completely removed or not. I don't think we
can presume either that glandular tissue is not removed along with fatty
tissue during the procedure. But given the variation in women's lactation
capacity, what functional glandular tissue is left intact may be sufficient
to maintain an adequate milk volume. As Theresa Gutsch stated, careful
follow-up is required to assess adequate onset of lactogenesis. We have
followed approximately 10 women with a history of breast reduction surgery
and only 2 have been able to maintain adequate milk volumes. Hope this info
helps.

Re: LC,IBCLC,CLE,CLC
Just wanted to put my two cents in about this issue. Although I think that
IBCLC does provide a means of some type of verification of your knowledge
base, it is not the only way to validate this. Like you, Theresa, as I am
sure many others, much of my knowledge and training was obtained before
IBCLC existed. I am currently the director of the Lactation Program and Milk
Bank at Texas Children's Hospital in Houston, TX. I am an RN with a Masters
in Perinatal nursing. I considered taking the exam when it was offered for
the first time in Houston a few years ago, but being in the middle of
graduate school, I did'nt have the time. Now that I have a little more time,
financially (with my eldest of 4 children starting college), it's not
something I can afford. I think that each LC has to assess what her
experience, education, and expertise in this area is, recognize her
limitations, and go from there. Just as you stated, some areas recognize and
may require the certification, others may not. It's great to have this
outlet (lactnet) to see the diversity in our area of interest. Thanks.