Things seem to be going reasonably well.  I would be more reassured about intake if you had
said the bowel movement on day three was yellow or at least transitional (in the absence of
supplements), because that is a sign of good intake of colostrum, and many women who do
well often have babies with transitional stools only on day four or five.  Since this mother has
had incisions only partly around the areolar, her chances are pretty good I think of doing just
fine.

I would not try too many things to decrease the engorgement on the underside of her breasts
unless she is truly uncomfortable.  Probably it would do not harm, but the engorgement in
any case would probably settle down in a couple of days.  Help her achieve the best latch
possible and use compression to increase transfer of milk to the baby.

I think that women should be warned that breast augmentation should *not* be done through
a periareolar incision.  It causes problems, usually severe, with milk supply.  Especially since
there are other approaches (an incision under the breast near the chest wall) which do not
interfere with breastfeeding, and, in my humble opinion, look better, why take the destructive
approach?

I won't step into the mine field of asking why women would want this type of surgery
anyhow.  I can't understand breast reduction, though many women have argued passionately
that they felt they needed it for medical reasons.  But it says oodles about our society and
women's place in that society, that women want to make their breasts "bigger".  There is no
medical indication for "augmenting" normal breasts.

A beautiful and sad example of why, if I were woman, I would *not* put my faith in *most*
breast plastic surgeons is a mother I saw who had a large and small breast after puberty.  It
was obvious that the small breast was hypotrophic (little breast tissue).  So what does the
surgeon do?  You guessed it--did a breast reduction on the *normal* breast.  A far more
complicated bit of surgery than augmentation on the smaller side using a posterior incision,
which destroyed this woman's chances of breastfeeding.  AAARGH!!!

Jack Newman, MD, FRCPC