Ellen,

I hope that if this mom opts for implant surgery, they at least avoid
interrupting nerve pathways, and that she be advised to talk with an LC
prenatally. Only pregnancy, plus attempting breastfeeding would give a
definitive answer in each individual situation.

Whether implants are inserted or not, I would advise following regular
standard approach to good breastfeeding management with close attention
to baby's weight pattern, and supplement if/as necessary. I remember
reading somewhere that even a smaller amount of glandular tissue could
respond with more rapid milk production with very frequent milk removal.

I had a teen age mom whose breasts sound pretty close to your
description, but diameter might be a little larger than a toilet paper
tube. I got some excellent pictures.

She came into WIC asking for formula at 5 days "because her baby wasn't
getting enough" I was later amazed at what a routine sell job I started
out with. Almost as an afterthought, thinking I could help her with the
engorgement stage so the baby would be able to transfer milk better, I
asked her to allow me to check her breasts, and asked her to drop her bra
flaps. She rather sheepishly said "I don't have to wear one", and lifted
her shirt. To my amazement, no engorgement, and breasts very close to
what you describe.

She had only been breastfeeding about 5 times/24 hours and giving formula
several times too. I figured "What could be lost by starting out with
standard advice?" She  was already following rule # 1 Feed the baby, with
formula, so I arranged for her to have a full supply of that. Her social
situation made it obvious that her support system all had a bottle
feeding preference, but were "allowing her to do her thing, as long as
the baby was ok, but don't expect any help or encouragement from them."
We arranged to have her bring him in for weekly weight checks till we
were assured he was gaining well.

Next, for Rule # 2, I told her I would arrange for her to get a hospital
grade pump in a day or so, to help stimulate her supply. In the meantime,
I encouraged her to go right to:

Rule #3, and fix the breastfeeding by letting the baby nurse at least 8,
or better 10 or 12 times or more in every 24 hours, and only feed a small
bottle after some of those feedings where he really seemed very hungry
after nursing.

By the time I made a home visit 48 hours later to deliver the pump and
shoot the prearranged photos, she was already dripping milk at frequent
intervals. Baby had always latched easily, nursed efficiently, and seemed
quite satisfied for 2 hours or so after most feedings, so he was getting
only a few bottles. I never did see any actual engorgement, but milk was
easily expressed, and she could pump an ounce or more from each side the
very first time she tried.

Her social situation was such that it alone predicted an abbreviated
breastfeeding experience (early return to school/work, family liable to
feed large amounts of formula in her absence, etc.) So when she called to
say she weaned at 6 weeks, I congratulated her on the great start she had
given her baby, and I meant every word of it sincerely.

Jean
****************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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