Tina wrote, "Help me answer a mom-to-be..........Maria had a breast
reduction .. but knows her chances of breastfeeding .. are slim"

There is no way of knowing how much milk Maria will be able to produce for
her baby until she tries.  This is always an individual thing - it is very
likely that she will produce milk, but what is uncertain is how many ducts
may have been severed, whether they may have re-canalized, and whether they
will drain. Quite apart from this is whether the milk-ejection reflex can be
stimulated - does she have sensation in the nipple/areola?  If so, the milk
will let down. If not, then drainage could be impaired, although she might
still be able to express/pump her milk for the baby.  In the early days the
risk of engorgement and subsequent mastitis is very high, she will need to
maximize breast drainage and be alert for lumpy areas in the breast, pain
and inflammation.  I believe an antibiotic is appropriate if this happens,
but I know this is in dispute!

"is there any reason to even try to BF?" - YES, YES, YES!

"If any mothers milk is produced, she will still have to suppliment with ABM,"
 - Yes, most likely, but in what quantity is difficult to say during
pregnancy, it may be a lot or it may only be a little.

"so what are the benefits?"  - Assure Maria that there are benefits to
breastfeeding which go beyond just making enough milk for a baby.  There are
the comfort/bonding/skin-so-skin benefits which you have mentioned, and she
can provide 100% of these even if very little breastmilk is being obtained
during nursing.  There are the disease/allergy-prevention/immunological
benefits, and these are also real, more is better naturally, but even 50ml
of breastmilk per day will help to keep her baby healthier than if the baby
received none at all and studies done on weaning milk (i e when breastmilk
production is not high) seem to show that these aspects become condensed
when the quantity of breastmilk reduces.  Then there are the nutritional
aspects - components of mother's milk which cannot be duplicated - even a
small quantity of these can be invaluable to the baby.

"should she use the SNS(?) system and offer ABM at the breast?"  I think
others on this list would say so.  I have never worked with a mom who used
an SNS, but supplements can be provided in a variety of ways (cup, spoon,
finger-feeding, bottle) and ideally delivered as *quickly* as possible,
leaving more time for nursing at the breast.  Ideally, too, mom should
express/pump *after* breastfeeding (once the baby is settled) to maximize
breast drainage and thereby maintain her supply.  Any EBM obtained can be
delivered during/after the *next* breastfeed.

"Should she allow baby to suckle at "naked" breast first and then add
the feeder?"  Yes.

"Would baby just get frustrated if no milk is immediately available?".  In
my experience, no.  The baby usually goes eagerly to the breast, sucks and
swallows while milk flows and then as the supply is "used up" gradually
indicates impatience.  Supplements can be fed before the baby becomes upset
and the baby can be put *back* to the breast again for comfort-sucking to
drift off to sleep.
Best wishes to Maria.  Even a little breastmilk is wonderful for her baby!

Pamela Morrison IBCLC, Zimbabwe