It's my observation that the more time that has passed since the operation,
the better the chances are that milk can be made and can be released thru
the nipples to baby. It is always wise to inform mom of the possible
problems and to monitor baby closely for s/s of sufficient intake. Two moms
I worked with who had great results, meaning little to no supplements in
the early weeks, were those whose surgeries did not involve total removal
of the nipple. Their surgeons left them attached (called a pedicle?) in the
center. They cut around the edge of the areola, reformed the breast, &
replaced the nipple/areola. One of these moms had a full term healthy baby.
It had been 8-9 years since her surgery and she supplemented from day 1.
She would have, anyway, because she was a business owner and was back at
work in 7-10 days. The other had a baby in Level III nursery. When I was
called in, it was to help her put baby to breast for the first time and she
had already been pumping & supplying gradufeeds full of milk. Mom had
already been discharged, was returning to visit baby & bring in milk. She
was the one who mentioned her surgery which was performed in Mexico about 3
years prior to the birth. Baby went on easily, like he was full term, &
swallows were obvious. I told her to thank her surgeon but went on to
caution her to monitor baby's s/s of sufficient intake - just in case her
breasts didn't keep up with baby's growing needs. I did see the sharp
definition of the edge of the areola, but did not see the verticle scar one
would expect to see leading down from the bottom edge of the areola to the
base of the breast. I did not ask her to lift her breast to show her scars
to me.

The mom who couldn't produce anything was the one whose nipples were
completely removed, then attached at an appropriate place for the sake of
appearance. What glands she had did fill with milk, but there was no way to
remove it.

Phyllis

--- Phyllis Adamson, IBCLC
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