Stim in the first few days can make all the difference.  Here's an example.
With first baby mom was given much extra help to confirm latch ok and she
pumped/hand expressed after every feed thru the first week and until supply
fully-established.  Despite the surgery she made 100% of her first child's
intake.  When 2nd came along mom incorrectly assumed that surgery not an
issue given success with first.  She didn't ask for help and I didn't see
her till around day 10 when already 50% formula.  Poor latch, insufficient
emptying = chronic low supply with 2nd.  Any mom who may have marginal qty
active glandular tissue will benefit from the very best stim in those
critical first 72 hours and on thru the first week.

Many of the reduction moms I meet make less than 10 oz/day and sometimes
just 3-4, despite good initial stim.  of course much depends on how much
tissue was removed and whether the surgeon was able to focus on function or
the level or surgery required sacrifice of function for aesthetics. No woman
is going to thank her surgeon for odd-shaped breast that lactates well!!

With some of these moms I get a sense that the tissue has been rearranged
under the areola such that pump better at extracting milk than newborn -
that "sweet spot" isn't there.

I do my best to reassure reduction moms not to second-guess their decision
(which of course they are generally doing with some tears) - many of them
then share their stories about difficulty living with very large breasts,
espec as teens.  

Joanna Koch, IBCLC

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome