Trish Welcome out of lurkdom. You described your client's scenario very well. You are right, there are a few issues. 1) how will her milk production be? 2)how will her engorgement be? 3)will she have primary lactation failure, i.e. her breasts are not properly developed for full lactation and that is why she got the implants? In any case, I would proceed w/ regular (read optimal) lactation management but follow her closely at least by phone, or preferrably by return appt and watch for breast fullness, infant output and wt gain. Treat the engorgement if it arises, the unemptied breast sections will involute. She may have enough milk w/o supplements or she may not. If she needs supps then offer alternate device, preferrably nursing supplementer at breast but this is mom's choice. I have seen many times where a doctor is not very worried about these types of things and neither is the mother, but lo and behold the baby is in real trouble. So bottom line is very close followup and intervene if needed. FWIW, I believe in the open-pause-close suck and audible swallow, but I swear once I saw a baby's first feeding in delivery room and I could swear he was really getting milk. His jaw was opening so wide and strong and slow. Later I find out this mom had br. reduction surgery and over the course of days/weeks working with her she only got tiny amts of milk. Maybe the baby was really swallowing that frist feeding? Laurie Wheeler, RN, MN, IBCLC Violet Louisiana, s.e. USA ______________________________________________________ Get Your Private, Free Email at http://www.hotmail.com *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html