The issue of what to say to the mother attempting to breastfeed after
reduction surgery (BFAR) is, as Diana suggests, really tricky.  I recently
ran into such a mom I'd worked with at a conf.  She gently chastise me for
not being more 'optimistic' about her chances for a full milk supply.  I had
evaluated her early on, and based on what was currently occurring, her
history, etc. I tried to paint a realistic picture of what I thought would
happen (since she was paying me for my opinion.)  I emphasized the
advantages of partial bfg. and said that I suspected that she might have
difficulties making a full supply.  She went on to prove me wrong.  Of
course, I'm delighted when that happens, and don't have any ego attachment
to being off the mark when the outcome is so happy for mother and baby,
although she probably thinks I'm an idiot.   However, I do feel very badly
indeed when I err in the other direction and a baby ends up in trouble
because I've been overly optimistic.  It is really, really hard to know what
a surgically affected breast is going to do.  We know that there is
glandular growth and proliferation with each pregnancy, and that the gland
continues to grow during lactation (Daly, Owens, Hartmann) so maybe (esp.
with increasing parity following the surgery) some mothers will recannalize
to the point that full sustenance of a baby is very possible.  Also, it's my
impression that the surgery has begun to be more careful with regard to
protection of the function of the breast.  !5 years ago when I saw my first
cases, the breasts were just not delivering milk to the outside; today, I
see many more successful experiences.

We take our best shots at trying to be of service in these situations, and
all of us who have worked with lots of BFAR moms have seen many of them with
severe lactational impairment.  So there is a lot of guess work.  I side
with Diana on the being realistic part, but always try to balance that with
encouragement.  And when I'm wrong, I'm glad.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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