Even though she breastfed well before implants, the surgical interventions
*may* have an effect on this lactation. To wit: more engorgement issues
which *can* impact milk production, nerve injury or disruption, sensitivity
changes, etc.
However, I would say the biggest factor would be use of the First Years
pump, which I don't rate as a very effective pump, in the experiences
shared by clients over the years.
I understand she was not happy with the Medela Pump in Style with her last
baby, I wonder if you could explore that more. Perhaps it was the flange
size or it was a used pump not working well, or she used it before an
established milk supply or something else not necessarily related to the
pump (For example a mother today telling of her history of low milk
production was pumping 3x per day during that time).  I think I would
recommend a hospital-grade (I still call it that) also called a piston
electric pump. In my region, mothers seem to have good results with the
Medela Symphony, the Ameda Elite or the Ameda Platinum. These are the only
rentals in our region. Also the Medela Lactina, but in my experience it is
not as effective.
Even if she wants to use a pump, if she can hand express plenty of milk,
she could combine that with pumping, or exclusively hand express - you
could explore why she does not see that as an option?
Laurie Wheeler RN MN IBCLC
Mississippi USA

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