Whether you have had a breast reduction or have breast implants, it is likely that you can still breastfeed after surgery. It all depends on how the surgery was performed. With breast reductions in particular, the surgery is so advanced that surgeons can typically preserve lactation tissue. With breast implants, If the implant is placed under the muscle and if the incision does not disrupt the perimeter of the areola, you are much more likely to successfully breastfeed. If not, you will most likely still be able to produce milk, but your supply may be somewhat limited with your first baby post-surgery.
Background
Mother Nature never ceases to amaze us! Even though breast surgery can damage the ducts and nerves necessary for breastfeeding, severed ducts and nerves can actually rebuild themselves through processes known as recanalization and reinnervation. Recanalization and reinnervation make milk production and expression possible during post-surgery breastfeeding and most mothers who have had breast surgery can still produce enough milk for her baby’s needs.
Pregnancy, labor, and birth prompt your mammary system to rebuild the structures in the breast needed to nurse. Recanalization, the process of severed ducts reconnecting or when new ductal pathways develop, usually takes place in direct response to lactation. While women have between 15 and 20 ducts in their breast, there are only between four and 10 ducts that go all the way through the breast tissue to the nipple. A woman with more ducts can afford to lose a few while still maintaining her ability to produce milk. A woman with fewer ducts is taking more of a risk by undergoing surgery. You would not necessarily know how many ducts you have and should consult with your physician to know.
Reinnervation is a nerve rebuilding process. The fourth intercostal nerve, found in each breast, is critical to milk expression. This nerve tells the brain to release the hormones prolactin and oxytocin which triggers milk to flow. If this nerve is damaged, milk expression does not happen as easily. But just like ducts, nerves can regrow and reconnect. This nerve grows back at a rate of about 1 mm each month, whether you're lactating or not. The more time that has passed since your breast surgery, the more likely that any nerve damage will have reversed itself. The nerve typically takes about five years to grow back completely.
Post-Birth
The first days post-birth are important for women who have undergone breast surgery. Because milk production follows the rules of supply and demand, feeding your baby at the breast “teaches” your body how much your baby needs and will help establish supply. This is especially important if you are at risk for damaged lactation tissue.
Damaged lactation tissue affects how engorgement looks and feels for a mom who has had breast surgery versus non-surgery moms. For all moms, as your body figures out how much milk you need, you might experience swelling, called engorgement. As a mom who has had breast surgery, the difference is that you may experience unequal engorgement where one breast gets more full than the other or one part of the breast is hard while another is soft. This probably means you have an unequal amount of healthy lactation tissue in your breasts or in one part of the breast. In this situation, you can address the engorgement by nursing more on that side or pumping a little more on that side to ease any discomfort. It is important to nurse on both breasts and not to rely only on the one that has more milk. It’s also helpful to know that moms who have had breast surgery may have more pronounced engorgement with their second baby.
To decrease your chances of engorgement, either nurse or pump frequently to ensure that your breasts are being emptied regularly. Nursing is the most effective way to ease engorgement.
Engorgement can make it difficult for the baby to latch on to your breast because your nipples can become temporarily flattened due to swelling. To reduce swelling you can also apply ice packs to your breasts or take a warm shower to let out some of the milk. Lansinoh’s LatchAssist™ Nipple Everter for breastfeeding can help evert temporarily flattened nipples with gentle suction so baby can latch.
Once you are 3 days post-birth, if you don't feel any fullness in your breasts, your prolactin levels may be too low or the fourth intercostal nerve has not recovered enough. It’s also possible that your surgery may have damaged the milk-producing structures in the breast. In this situation, it is best to discuss your concerns with a lactation consultant who can make an appropriate assessment about your milk supply.
Each woman is different and can experience different challenges while trying to breastfeed after breast reduction or surgery. If you have questions or want to learn more about breastfeeding after surgery, talk to a certified lactation consultant or health care provider who is trained in breastfeeding and lactation.
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