Camille wrote about a baby 6 wk pp who continually falls asleep at breast
without feeding tube device opened up.  Mom has had breast surgery.
Typically, there is plenty of glandular tissue left post-reduction.  The
problem is that while mom gets engorged initially, there may be interrupted
breast drainage, resultant retained milk, which triggers involution and
atrophy (ie weaning of some of the lobes of the breast.)  There probably are
some lobes which are still productive, and which do drain to the surface,
but it is often true of reductions that production can be quite impaired.  A
baby who falls asleep at breast unassisted , but who will stay wakeful and
suck well with an augmented flow is testimony to low milk supply.  I think
the explanation of too early access to hind-milk is a more complicated
explanation than what is probably occurring.  It is sad when unrepairable
impairment hampers full production., but it is great that  mom has a partial
supply to offer, and that she is willing to use the tube and do the
mothering at breast.  With future babies, she may see some regeneration and
more milk.  I have seen this happen.  Reductions are tricky, as there are so
many variables and so many outcomes-- from full supplies to none.
Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html