Louise Denhenz asks about breastfeeding after surgery. Here's what I know:

The removal of glandular tissue is only part of the picture. Any breast
surgery can sever the nerves leading to the nipple/areola complex,
resulting in no (or little) neuro feedback to support the endocrine aspect
of milk production, which appears to set the maximum potential for milk
synthesis for that particular lactation cycle. When she grows this glanduar
tissue, and how much she normally develops, certainly play a role.

A big factor appears to be how much of the breast secretory tissue develops
prenatally, while blood flow is distributing the hormones and developing
the alveolar cells. During each pregnancy, the secretory (glandular) cells
develop/grow on the basement membrane; this growth continues until around 6
weeks postpartum. Peter Hartmann's research has shown that there are wide
individual differences in patterns of breast development among women - some
will grow most of the glandular tissue early in pregnancy; some experience
even, steady growth; and others develop much of the tissue in the last
trimester and even early postpartum. Once the mother births her baby, any
further cell growth depends on nerve responses from the nipple to trigger
prolactin bursts. Autocrine feedback kicks in at birth and is the major
player in ongoing (maintaining) milk synthesis by as early as the first 5
days, and is nearly fully responsible for maintaining milk supply by 3
months.

If most of the mom's secretory cells develop before the baby is born, AND
the baby (or something else) removes milk frequently and thoroughly early
and consistently, chances are improved for adequate supply. If she's a
late-developer of glandular tissue and/or milk removal is delayed, her milk
supply would be in more jeapordy because the postpartum endocrine mechanism
is disrupted by the lack of intact nerve pathways caused by the surgery.

This mom had implants - I would ask WHY. Did she EVER develop sufficient
glandular tissue to support lactation during any of her pregnancies? If
she's on the "lower" end of the bell-shaped curve regarding the amount of
glandular tissue she develops, she probably needs every cell to be working
at maximum output all the time to make milk for one baby. Any disruption
may push her under the lower limit of "adequate." A mom on the high end of
the curve may develop enough tissue to nourish several babies without half
trying, and may not be as affected by surgery of any kind. If the "high
end" mom loses some nerve feedback or secretory tissue, so what? she's got
plenty to spare.

Linda Smith, BSE, FACCE, IBCLC
Dayton OH