June, the mom with thyroid disease may have had poor breast development
during adolescence as the result of the thyroid disease. This (rather than
just the desire for big breasts) may be why she sought augmentation.  I
generally ask moms who have had augments if they had normal breast
development, and often they tell me that they had unusually shaped breasts,
marked asymmetry, or extremely small breasts.  While extremely small breasts
can make totally normal amounts of milk, some women with amastia have such a
scant amount of glandular tissue that they can't produce a full supply.  So
the underlying issues (rather than the surgery itself) are the reasons why
there is poor milk production.  Add to this the understimulation you report
(pumping only once per 24 hrs) and you have a recipe for starvation for the
baby.  Taper the formula only as it becomes clear the maternal production is
coming up to normal.  Consult the standard texts for a view of what normal
milk production for a singleton is.  The range is from 19-30 oz/day.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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