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

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html