Hi to all.  Wanted to share 2 recent situations both involving women with
breast implants which ought not to have impacted lactation, given that
incision sites were below the breasts in mammary fold. Both moms had
discussed with surgeons a desire to bfeed.  One mom G2P2 had a very rough
time with 1st baby which she blamed for slow growth and early weaning.  Very
determined to do things diff. this time, and did:  total rooming in, no
bottles, freq. feeds, good duration.  Baby below birth weight at 2 weeks pp,
very lethargic.  Right nipple partially numb.  Left good sensation.  Put her
on pump to see what vols.  She pumped at each feed q3hrs for 3 days and very
consistently pumped 2 oz from left breast, and only about 1/2 oz from right.
Delivered all pumped milk plus additional formula to bring baby out of the
doldrums.  Baby gained 9 oz in 4 days and is very much happier.  We are
going back to breastfeeding now with some assumption that intake will
average about 2.5 oz per feed, which may not meet all baby's growth needs,
but will be a good partial supply. She will comp up per baby's cues, and
monitor growth carefully.

Other mom is primip. Same type surgery and similar scar configuation.  Same
presentation.  Baby of 3 weeks not at birth weight.  Mom called me to
complain baby had colic (I had seen her for a pre-natal and had followed up
in 1st week pp at which time she told me all was going well with pee and
poop WNL.) When she called at 3 wk, she reported baby had not been at birth
weight at 2 wk pedi visit, but that pedi wasn't worried as baby was within a
few oz. I told her I wouldn't counsel over the ph. for colic until baby was
brought in for weight check to rule out hunger.  Sure enough, baby scrawny
and frantic - had gained about 1 oz in 7 days.  Again, positioning fine,
freq. excessive (baby feeding an average of 14-16 times per day.)  Clearly
baby was feeding constantly just trying not to slip any further with such a
depressed milk supply.  Mother was very negative about baby's behavior --
frustrated that baby was "a lot of trouble."  Beginning supplements while we
see where the supply is and where it can go has helped mother's attitude
toward baby, and baby is not nearly as unhappy now she isn't starving.

Just a reminder to recall that any type of breast surgery -- even if the
scars are the "good" kind -- creates a three-fold increase in risk of
lactational insufficiency.  Phone counseling has limitations, and weight
checks are the impirical way to rule out certain problems,  allowing the LC
to safely focus on other counseling recommendations.

Barbara

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