Molly and Laurie,

Bromocriptine is no longer used for lactation suppression because it can
have dangerous side effects and, more importantly, it doesn't work.  Most
women experience rebound engorgement after finishing the prescribed course
of bromocriptine.  Why take unnecessary risks if the treatment is not
effective anyway?  Traditional measures, as Laurie suggested, can be more
effective.  I would hesitate to bind her breasts.  She probably still has
discomfort and sensitivity in the scar and nerve endings from the
mastectomy.  A smooth tube top or sport bra will do the job just as well and
more comfortably.  She can apply hydrogel dressings over the mastectomy scar
to prevent irritation or cut the cup out of a regular support bra to prevent
it from rubbing against the scar.  Plain white cotton t-shirts are
comfortable over the scar. 

She should not experience engorgement in the mastectomy site but, yes, it's
impossible to remove 100% of the glandular tissue.  What small amount does
remain should not become painfully engorged, unless she has accessory breast
tissue in the axilla.  Besides what Laurie suggested, she could also take
peppermint Altoids or Mentos regularly and/or diphenhydramine or
pseudoephedrine.  If she is estrogen-receptor positive, she will most likely
be started on Tamoxifen postpartum.  Tamoxifen blocks estrogen in the breast
so that should help with involution as well.

Another alternative is to partially breastfeed for a few weeks on the
healthy breast and wean slowly over those weeks rather than not
breastfeeding at all.  It could really help reduce mom's stress hormone
levels and help her with the grieving process associated with the
mastectomy.

I wish this mother many healthy years with her family.

Linda Anderegg, BSN, RNC, IBCLC, breast cancer survivor

 

<<<Date: Mon, 15 Jun 2009 21:52:42 -0700

From: Molly Brannigan <[log in to unmask]>

Subject: Preventing Milk Surge

I have an acquaintance who has become sort of a client. She is 32 weeks
pregnant and was diagnosed with breast cancer two months ago. She had one
breast removed 8 weeks ago, and will be starting her second round of
chemotherapy this week. She will then take a 4 week break from chemo, before
delivering her baby by c/s at 36 weeks. Two weeks after that she will begin
the first of many more rounds of chemo. On advice of her perinatalogist and
oncologist, she has decided that she will not breastfeed at all.

I would like to give her some anticipatory guidance as to what will happen
in the hospital and early days regarding her milk.

She has older children that she breastfed without problem for a long time,
so I am thinking that there is a likelihood that she will experience an
early and robust milk surge.

My question is for those who work in hospitals - what kind of care for
engorgement and reducing milk supply is likely to receive? What are the
range of options she is likely to be offered, and what strategies could she
request. Her chest is still very sore from the surgery. Pardon my ignorance,
but will she be given medication to dry up her milk, or is that completely a
thing of the past?

Her oncologist is very concerned that any infection would slow down the
chemo schedule, so it is important to avoid even an inkling of mastitis.

Is it likely that she will get any engorgement on this side with the
mastectomy? I imagine that they try to get all the breast tissue but could
there be some remaining? I do not have the details of the surgery, but I do
know that in discussion with the doctors she was adamant that preservation
of tissue for reconstruction was unimportant.

Sorry for such basic questions. I am relatively new and work in private
practice - this is entirely outside my realm of experience!

Thank you,

Molly Brannigan, IBCLC>>>

 

<<<Date: Tue, 16 Jun 2009 11:01:35 -0500

From: laurie wheeler <[log in to unmask]>

Subject: preventing milk surge

If it is not contraindicated and if ordered by her physician, the mother
could be given bromocriptine. This drug is no longer ROUTINELY given to
postpartum women who do not wish to bf. But it can be prescribed for other
reasons.

From MayoClinic.com: bromocriptine can be used "To stop milk production
after an abortion or miscarriage or in women after a delivery who should not
breast-feed for medical reasons."

If contraindicated for this mom, or if mother chooses to use non-drug means
of drying up, many OB doctors and nurses recommend a somewhat tight bra, as
little breast manipulation as possible, ice packs or cabbage leave
treatments, and expressing minimally to prevent engorgement and/or mastitis.
Sage is an herb that is also used for drying up. One place I worked for 3
yrs routinely placed moms in a snug velcro binder if they choose not to bf,
and I did not see/hear of any problems using this method, altho I know many
folks do not recommend binding.

Laurie Wheeler RN MN IBCLC

Mississippi USA>>>


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