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Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 20 Aug 1998 15:14:26 -0500
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I am working with a mother who, only 3 1/2 years ago had breast reduction
surgery, including moving her nipples.  She was firmly discouraged by the
hospital LC from considering breastfeeding her baby, but she didn't give up
hope.  She is 38 years old, which would explain some of her "spunk." She
had also breastfed a baby 20 years ago.

When I was called in, baby was 4 days old and there hadn't been much
evidence of milk. After our first session in which baby latched beautifully
and in which we did hear swallowing, the mother noticed more breast
fullness.  She was so pleased that I was encourging of her efforts.

The next day milk was flowing very well, and she was leaking from the
alternate breast.  Such joy as she exclaimed to her husband, "Milk is
dripping all over my lap!" Needless to say this baby is thriving on her
mothers milk, which is flowing from post-surgical breasts, and whose
lactogenesis progressed in a  normal pattern

There are areas of her breasts that grew hard for a couple of days and
which were relieved with cabbage leaves.  Mom said that the nipples were
moved up and reattached, but that the surgeon said that he preserved as
much duct work as he could.  I don't understand what was done, but for
restoration in so short a time, care must have been taken.

I told her to stop telling people that she had had the surgery, as it just
invites alarm about her supply, which is obviously fine, and judgement
about her choice.  I think that we need to not be so quick to caution a mom
about her ability to feed her baby when she has had surgery.  We can follow
her closely, as we do any baby, but our doubts can quickly become her
doubts, and then low supply.

I am going to see a mom today with a 2-week old who is not breastfeeding
because the two hospital LCs told her she couldn't, because 17 years ago
she had breast reduction surgery.  After a difficult delivery with
separation from her baby,  she is depressed and wishes "that my baby was
still inside me." Dad is doing most of the caring of the baby as mom is not
bonded with a baby that she doesn't feel is hers. She did have engorgement,
but was cautioned to not take any milk out.

You may wonder what I am going to do there.  I don't know yet, but I was
called, and I'm going to see what I can do other than encourage her to see
a good counsellor, which is already planned, along with possible
anti-depressants.

One thing that I'm going to do is get the baby into a sling on mom's body
and show some infant massage strokes.  There hasn't been mention of
relactating or SNS feeding, but that is in my mind as a possibility, as
baby is only 2 weeks old.

I have recommended my wonderful Cranio-Sacral practitioner to work with
both mom and baby.

Both of these cases could have been handled better if more LCs knew that
breastfeeding after breast surgery is possible and should be encouraged
without undue warnings. I have had more women with inadequate milk supplies
or no milk at all who *didn't* have breast-reduction. In both of the above
cases the women were told that, even if they could make milk, it wouldn't
have a passageway out because of the severed milk ducts. And they were
ashamed to have made the decision to reduce their breast size.

If I am asked before the birth, I say, "Let's assume that you can make a
full supply.  If we find otherwise we will deal with it."

I suspect that we will be seeing more of breast-reduction cases.

Patricia Gima, IBCLC
Milwaukee
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