How does breast surgery affect breastfeeding?
Some women have had a breast lump removed before they ever got pregnant; a few need a breast lump biopsied or removed while breastfeeding. Others have had plastic surgery to make breasts larger or smaller.
Biopsy or removal of a lump before breastfeeding
If you have to have a lump biopsied or removed, and there's any chance you might one day want to breastfeed, have a thorough discussion with your surgeon first. As little breast tissue as possible should be removed, and the incision should sever as few milk ducts as possible. If the lump isn't easy to feel, your surgeon may localise it first with dye or a wire. If you've had a biopsy, you won't know whether you can breastfeed until you try. However, if - even with the best advice and support - you can't feed from the side that had the biopsy, simply let the milk in that breast dry up (by not feeding from it and by expressing only the tiniest of amounts to stop it hurting). You're highly likely to be able to make all the milk your baby needs from the other breast.Biopsy or removal of a lump during breastfeedingMake sure your surgeon knows you are breastfeeding and wish to continue. He or she can then take great care to cut as few milk ducts as possible. Breastfeed your baby as close in time to the start of the operation as possible, and ask the nurses to bring him to you afterwards. They will also help you breastfeed from the other breast as soon as possible. Feed from the operated side as soon as you can; you may find it helps to press very gently over the dressing while you feed.Breastfeeding after breast reduction surgeryYou may be able to breastfeed if you've had surgery to make your breasts smaller. Whether you can breastfeed fully depends on how much glandular tissue was removed, how many milk ducts were cut, whether the cut ends of the ducts have managed to join up with open ducts so milk can get to the nipple, and whether the milk glands with intact ducts can produce enough milk. In one type of operation, the nipple and areola are cut away completely before being transplanted higher up. In the other, they are left attached to some breast tissue so some ducts remain intact.
The longer between surgery and pregnancy, the more successful breastfeeding is likely to be. The only way to know whether you can breastfeed successfully is to try. Even if you manage to give your baby only a little milk each day, it's worth it for both of you. An 1994 Australian survey of 30 women who had a baby after a breast reduction found that of the 93 per cent who wished to breastfeed, 73 per cent were doing so when they left hospital, and 27 per cent three months later (though only one woman was exclusively breastfeeding).
If you contemplate this operation before you have children, and think you might ever want to breastfeed, be sure your surgeon knows so he can leave as many milk ducts intact as possible.Breastfeeding after breast enlargement surgeryMany women breastfeed successfully after having breast implants. However, this surgery can cause problems with breastfeeding. A 1996 US study found that 64 per cent of breastfeeding women had insufficient milk after having implants, compared with fewer than 7 per cent of breastfeeders who didn't have them. An incision around the areola was more likely than an incision beneath the breast to be associated with a poor milk supply.
Dr. Penny Stanway
June 2009
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