I would be concerned about the pressure and milk fistula as well however:

Looks consider what might happen if she doesn't breastfeed.
She will become engorged.
Engorgement leads to increased pressure and milk statis.
Milk statis leads to mastitis.
Mastitis leads to an abscess.
Incrased pressure increases the chances of the incision site rupturing.
A fistula may form.

If a milk fistula develops as it does can post an abscess--it heals.  If the
incision site ruptures---it will heal.

Before giving this mother her options I would want to know more about the
surgical technique.  Was the nipple and ducts to the nipple left intact?
Does she have normal sensation of her nipple and areola?  Was any glandular
tissue left in place?

Assuming she has some intact sensation, gladular tissue and a duct
system--her chances of breastfeeding on the affected side without problems
until radiation are good.

On the other hand if she has gladular tissue but no place for the milk to go
.  She will probably get engorged again irrespective of whether or not she
breastfeeds from the otehr side.

SHe has three choices:

Not to breastfeed
Breastfeed from both sides
Breastfeed from the unaffected side.

Obviously she may make a different choice given how intact her breast is.

What I would tell the surgeon is that you can't stop or prevent engorgement
postpartum and so she may develop all these problems irrespective of
breastfeeding.  NOt breastfeeding may even increase her risk of these
problems.  I once pumped 25 ounces from a woman who was engorged.  Ask him
what that might do to his suture line.
And then discuss her possible choices.  He should be able to give some input
about the anatomy of her new breast and how feasable breastfeeding from both
sides is.

Obviously, it is very important to give her the best care and prevent her
from becoming engorged irrespective of her choice.  A lactation consult the
first day post-partum and a high grade double pumping system available in the
hospital and at home.
In a message dated 8/1/02 6:57:48 PM Pacific Daylight Time,
[log in to unmask] writes:

> Just underwent a modified radical
> > mastectomy. She is 35 weeks pregnant. She wants to breastfeed! The
> surgeon
> > is talking about waiting on the radiation therapy for about 6 weeks
> > postpartum and no Chem at this point. The surgeon is open to the mom
> > breastfeeding on the unaffected breast but is concerned about the
> pressure
> > of the milk coming in against the post surgical breast tissue and also
> > concerns about a milk fistula forming on the affected side.
>

Christine Betzold NP IBCLC MSN
www.starfireinternational.net/breastfed

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