I think Margery's point to tell moms to "try it and see if it works" post
breast surgery is a good one.  As I said, I am often surprised.  I have seen
several moms with periareolar incisions who made decent partial supplies, and
one who made what appeared to be a supply totally within normal limits (WNL)
for a newborn.  We never could get her past pain while nursing (was this
caused by the surgery?  Good question. She told me in our pre-natal consult
that her right nipple hurt some ever since the surgery even when not preg.
or, later, while nursing.)

 I have seen a range of sequelae in reductions which include everything from
total impairment to a full supply.  There are different surgical techniques
from a sort of peel back and sculpt approach, to a scoop and dump kind of
mentality.  The nipple can be kept attached to a central cone of tissue
(inferior pedicle technique -- and it may be known by other names) or it can
be detatched and re-sewn.  The skill of the surgeon, the committment she/he
has to preserving function and senstation, and the kind of discussion mom has
prior to surgery about preserving lactation capacity are all issues.
 Unfortunately, many young women deny interest in lactation until preg. Then
they often express feelings which range from shame to regret.  I think
doctors must be educated to understand this phenomenon and they must take
responsibility to do what they can to preserve breast function. And I still
think that any breast, or chest surgical hx should be a red flag for the
early lactation to be supported carefully.  Blanket statements ("Sure, no
problem", or "You won't be able to nurse"  don't get it -- there are too many
exceptions -- and I have seen many babies in trouble one way or another
because the individual situation wasn't carefully assessed.
Barbara Wilson-Clay, BSE, IBCLC
Austin, Tx  priv. pract.