From the World Health Organization and pediatricians to Instagramming moms and even the First Lady, the verdict is in: breast is best for feeding babies. According to research, the “liquid gold” can protect baby from illness while increasing his IQ and strengthening the bond with his mother.
Even for the typical mom, establishing a strong nursing relationship can be tricky, what with sore nipples and shallow latches. But for women who have had breast surgery—whether for a reduction or augmentation, or even cancer treatment—breastfeeding can be especially challenging. With a little foresight and advance planning, though, women can go under the knife knowing that the ability to provide their baby with the best nutrition nature intended is still very possible.
Milk supply may be affected
According to Leigh Anne O’Connor, a board-certified lactation consultant in private practice, breastfeeding after surgery is only completely impossible if all of the mammary tissue (the glands that actually produce milk) has been removed, or if there is extensive scar tissue that impedes the function of the tissue. But even if it isn’t all lost, some of the tissue may be damaged or removed, which can have an impact on a new mom’s milk supply.
“Moms have better [breastfeeding] results if the nipple is not completely removed during the surgery, as this can really damage more milk ducts,” says O’Connor. “And moms who have had surgery may have a reduced storage capacity, so they may need to empty the breasts more frequently—this means more nursing than other moms.”
Also, adds O’Connor, women who believe that breast augmentation can increase their odds of successful breastfeeding and/or help them produce more milk are sometimes surprised to find that the surgery actually decreased their chances. Others still learn that they suffer from Insufficient Glandular Tissue, or IGT, which means that their breasts never fully developed enough glands to produce an adequate milk supply.
“In many cases, if the mom does prenatal hand expressing of colostrum in her final weeks she can get a good start to establishing her milk as well as have a good supply for her newborn,” O’Connor says. “For most of these moms, I recommend a hospital-grade pump—the kind you rent—to help establish a solid supply.”
O’Connor believes that hospital-grade pumps do a better job of completely emptying the breast and stimulating more milk production than store-bought pumps. Working with a lactation consultant and trying different supplements and herbs can also help bolster milk supply.
Cancer is not a dealbreaker
When Patty Evans was diagnosed with breast cancer at age 28, her first priority, of course, was to beat the disease and live a long, healthy life. Her second goal was to have children and be able to breastfeed them.
“For me, having a lumpectomy with chemo and radiation provided an equivalent outcome to having a mastectomy,” Evans says of her treatment protocol that was shaped, in part, by her desire to breastfeed. “Only having a lumpectomy on one breast and not having any surgery on the other breast allowed me to still breastfeed. My right breast received the lumpectomy as well as radiation; as a result, I could not feed from that breast. Since my left breast was not subject to these treatments, I was still able to breastfeed from it.”
While breastfeeding was still possible for Evans, it was challenging to nurse from only one breast as, like other mothers who have had breast surgery, she struggled to maintain her milk supply. “I tried lots of things to increase supply, like drinking tons of water and mother’s milk tea, pumping and taking fenugreek,” says Evans, who is now the VP Finance at Breastcancer.org. “I also supplemented with formula, which I was comfortable doing. While it would have been great to exclusively breastfeed, I had to do what was best for my baby, me and the rest of our family. Having a baby after cancer was such a blessing, and being able to even try breastfeeding was a bonus. So I told myself ahead of time I would try to make breastfeeding work as long as I could, butI wouldn’t put any extra pressure on myself if I had to supplement or even stop breastfeeding.”
Evans acknowledges that her path may not work for all women facing breast cancer, as a mastectomy may be the only treatment available for some. But she recommends at least trying for any woman who has the desire to breastfeed. “Make sure you talk to your oncologist and have a plan for your regular screening mammograms and/or MRIs,” she advises. “You generally won’t be getting these while you are pregnant and nursing, so make sure you understand the risks of delaying screening. Try to deliver at a hospital that is very supporting of breastfeeding. They generally have great lactation support services, which can be so helpful, especially the first few days. And freezing a supply of excess milk when you’re able to can extend the overall time period your baby is able to have breast milk, if your supply starts to dwindle. Enjoy all those special moments with your little one, and remember that just having a baby is such a victory after being treated for breast cancer!”
Know your procedure
Dr. Melissa Doft, a plastic surgeon and Clinical Assistant Professor of Surgery at Weill Cornell Medical College in New York, takes a different approach to her work when she operates on women who plan to breastfeed. “With a breast augmentation, desensitization of the nipple-areolar complex can result in a poor sucking reflex, leading to decreased milk letdown,” she explains. “Additionally, infection and capsular contracture can potentially lead to further operations which may lead to additional scar tissue and damage of the mammary gland. I prefer to make my incision on the inframammary fold under the breast, so to avoid the nipple areolar complex.
“When performing a breast reduction in a woman who is planning to breast feed, I try not to undermine, or detach, the pedicle on which the nipple is attached from the chest wall. In essence, I do everything I can not to increase scarring around the nipple-areolar complex.” To reduce pressure on the new scar after the procedure, which can also inhibit the ability to breastfeed, Doft advises her patients to avoid wearing an underwire for the first six weeks after surgery.
Whether the surgery is planned as a breast reduction, an augmentation or to remove cancer, the actual procedure—including where the incision is made—can have the most significant impact on a woman’s ability to breastfeed in the future. It is important for women to be aware of the different surgical options for her unique situation and to effectively communicate her desired results with her surgeon. “I would ask the surgeon how breastfeeding may be affected by the surgery and if the surgeon changes her technique depending on the age and potential desire to breastfeed afterwards,” says Doft.
Dr. Elliot Hirsch, a Los Angeles-based plastic surgeon agrees. “Women who are considering breast surgery and planning to breastfeed should make sure that their surgeon is aware of this so that the surgeon can try to minimize breast trauma and damage to the breast tissue as much as possible,” he says. “While it is sometimes difficult to do so, especially in oncologic cases, bringing it to the surgeon’s attention can help facilitate a dialogue so that both the surgeon and patient are on the same page.”