L. Rosetti posted a request for info on nursing after breast reduction surgery. I think that the recent posts on consequences of nerve damage and ductal severing after augmentation surgery contain relevance to those counseling women who have had breast reduction surgery. Any surgery which severs the 4th intercostal nerve and cuts ducts is going to negatively impact lactation. The big question is how much damage has been done. There are surgical techniques used on reductions which preserve some function, and I have seen at least 2 women with what appeared to be totally normal lactations following reductions. However, I have also seen very dehydrated, orange babies with very high bilis, who needed readmission to hospt. because care givers were taking a casual wait and see attitude. Questions to ask when trying to make your best guess as to what is going to happen: Do you know what kind of technique your surgeon used? Did you discuss lactation with the surgeon at the time? Was the nipple left attached to a cone of breast tissue while excess fat was sculpted, or was nipple detatched and then sewn back on in the center of the newly fashioned breast? (the latter being the most destructive of function.) Is there nipple sensitivity? Using info from Nancy Hurst's new article, I'd look closely at the exact location of the scar around the areola. Some of the plastic surgery ref. on reductions talk about the vol. of fat removed from the breast as a predictor of function. Remember there is lots of glandular tissue left in most breasts which have had reductions. I've seen women with a pound of tissue removed from each breast, and they were still C or D cups. It is less certain what the hook-up situation is. Post-partum supervision of these couples should involve anticipatory guidance for parents to assess feeding adequacy in light of early discharges. Babies need early and freq. pediatric monitoring to preclude dehydration and jaundice. Mother may produce partial supply. Feeding tube devices can be a good choice to promote mothering at breast, and maximal delivery of what milk can be produced. Caloric intake can be assured with formula. This feeding method can assist in calculations of how much milk mom is making. Mom may get horribly engorged and not be able to get any milk out of the breast. She'll need comfort measures (cold and cabbage, etc) while she involutes, and grief counseling. For new LCs who have not had first hand exper. with many moms who have had surgery, you can read about it in the standard lactation texts, and go to the primary sources in the plastic surgery lit. Which is what we all must do if we are presenting ourrselves as experts on lactation in special circumstances. This is a science and we must be serious about doing our homework. Barbara Wilson-Clay, BSE, IBCLC priv. pract. Austin, Tx