I have found a similar scenario with some mothers who have had reduction
surgery. I explain it as a change in the contour of the breast which
affects physiology. Currently, I am working with a client I have known
for many years, since her first was about 9 months old. After he weaned
she had a mastopexy, a "lift", with periareolar incision, repositioning
of the nipples, and liposuction- basically a reduction type surgery
topped off with implants to "perk them up".
When the first son was 6 years old, she had a second baby. It was a
terrible lactation experience with extremely traumatized nipple tissue
for weeks, compromised supply, and interventions from pumps to
domperidone. She was so regretful after having such a perfect first
breastfeeding experience. After using a SNS for months, the baby weaned
to bottles. 
Then came baby 3, 11.5 lbs at birth. This time she had some soreness in
the first weeks, a slowly building supply which took 4 months to
maximize, and overall a better experience. She was told by one LC to
just give up in the second month but persisted and was able to have a
happily gaining baby with one four ounce bottle a day. Until her next
pregnancy encouraged him to wean around one year.
Now she has baby 4, born at 9lb 10 oz, and he is gaining perfectly, no
soreness at all, and she is amazed. Me too!
Tissue may continue to change and heal with subsequent pregnancies,
although most of our clients will not be looking to have a house full of
boys! I would encourage mothers who have had surgery to expect change,
if not during one lactation experience, during subsequent pregnancies.
No guarantee, of course, but this experience could be very different
than her last. 
Debra Kearney Brown IBCLC

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