L. Rosetti posted a request for info on nursing after breast reduction
surgery.  I think that the recent posts on consequences of nerve damage and
ductal severing after augmentation surgery contain relevance to those
counseling women who have had breast reduction surgery.  Any surgery which
severs the 4th intercostal nerve and cuts ducts is going to negatively impact
lactation.  The big question is how much damage has been done.  There are
surgical techniques used on reductions which preserve some function, and I
have seen at least 2 women with what appeared to be totally normal lactations
following reductions.  However, I have also seen very dehydrated, orange
babies with very high bilis, who needed readmission to hospt. because care
givers were taking a casual wait and see attitude.  Questions to ask when
trying to make your best guess as to what is going to happen:   Do you know
what kind of technique your surgeon used?  Did you discuss lactation with the
surgeon at the time?  Was the nipple left attached to a cone of breast tissue
while excess fat was sculpted, or was nipple detatched and then sewn back on
in the center of the newly fashioned breast? (the latter being the most
destructive of function.)  Is there nipple sensitivity?  Using info from
Nancy Hurst's new article, I'd look closely at the exact location of the scar
around the areola.  Some of the plastic surgery ref. on reductions talk about
the vol. of fat removed from the breast as a predictor of  function. Remember
there is lots of glandular tissue left in most breasts which have had
reductions.  I've seen women with a pound of tissue removed from each breast,
and they were still C or D cups. It is less certain what the hook-up
situation is.

Post-partum supervision of these couples should involve anticipatory guidance
for parents to assess feeding adequacy in light of early discharges.  Babies
need early and freq. pediatric monitoring to preclude dehydration and
jaundice.  Mother may produce partial supply.  Feeding tube devices can be a
good choice to promote mothering at breast, and maximal delivery of what milk
can be produced. Caloric intake can be assured with formula.  This feeding
method can assist in calculations of how much milk mom is making.  Mom may
get horribly engorged and not be able to get any milk out of the breast.
 She'll need comfort measures (cold and cabbage, etc) while she involutes,
and grief counseling.

For new LCs who have not had first hand exper. with many moms who have had
surgery, you can read about it in the standard lactation texts, and go to the
primary sources in the plastic surgery lit.  Which is what we all must do if
we are presenting ourrselves as  experts on lactation in special
circumstances.  This is a science and we must be serious about doing our
homework.

Barbara Wilson-Clay, BSE, IBCLC
priv. pract. Austin, Tx