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Date: | Fri, 4 Feb 2005 18:23:32 -0500 |
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David,
I offer prenatal consultations to women who had breast reductions or
lifts. I ask them to send me a copy of the surgical report in advance,
so we can discuss the possible implications of their procedure.
I ask about/examine for: nipple sensation (poor sensation is a sign of
greater nerve injury) and shape (sometimes in the quest for best
esthetic outcome, the nipples are positioned so that they are difficult
for the baby to access), amount of tissue removed (the more tissue
removed, the more terminal end buds are removed, which are the future
lactocytes), time since the surgery (there is some regeneration), type
of surgery (inferior pedicle usually has better outcome in regard to
supply than free nipple graft).
I educate women on positioning and latch, how to know baby is getting
enough milk, danger signs (stellate nipple cracks especially, but any
nipple pain and damage), and what their options are if milk supply is
reduced- pumping, seeing a breastfeeding medicine specialist for
galactogogues, using supplemental feeding devices at breast.
I find that women who have significant supplies breastfeed about as long
on average as mothers wo do not have reductions; whereas those with very
low supplies drop out pretty quickly. I'd like to see research on
breast reduction vs breastfeeding duration control for supply issues.
Many moms tend to feel it is not "worth it" if they are getting little milk.
Other potential issues - pain from stretching of inelastic scar tissue
during feeding or pumping, potential injury to the sensory nerve under
the areola that provokes MER.
Catherine Watson Genna, IBCLC NYC
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