Q: I am 14 weeks pregnant. I had breast reduction surgery 15 years ago and
also have inverted nipples (not as a result of the surgery). Is there
anything I can do to increase the chances that I'll be able to breastfeed?
Does anyone know the stats on the percentage of mothers who can breastfeed
following breast reduction?
-Liza
====
A friend had a reduction and also runs a website and an email list for
women who want information about breastfeeding after a reduction. You can
sign up for the list at the website
http://www.magsi.com/liquidgold/index.html
If midwives and other professionals would like information, she has a list
for them to learn more too; you can sign up at the same website for the
information list.
-Belinda Bohnert
====
1. Inverted nipples: Some actually claim that employing Hoffman's technique
and/or wearing breast shells (NOT nipple shields) during pregnancy is
helpful in drawing out inverted nipples. The theory is that there are
adhesions at the base of the nipple that need to be released. First of all,
who diagnosed this? Are your nipples truly inverted? Do they ever come out
(like when you're cold). Even if this is the case, the most important thing
is to get the baby latched on well to the breast (they don't suck on the
nipple, unlike with artificial-feeding), and to avoid the introduction of
artificial nipples/teats until baby is nursing & gaining WELL. Which brings
us to the next issue:
2. Breast reduction: This is the more difficult one. While you will
*produce* milk in the remaining glandular tissue (and most women are not
reduced to an "A" size!) there is always a question of how much is actually
getting to the baby, due to the interrupted pathways. There is some
evidence that some recanallization of the ductwork *may* occur, but it is
impossible to predict or evaluate how much. Find out from your surgeon
exactly what was done: How much was taken out? Was the nipple completely
detached and "pasted on" or was a pedicule used?
In either case, I strongly suggest that you discuss your situation with
several La Leche League leaders and/or lactation specialists (knowledge
base and experience varies, so keep asking) as soon as possible. You will
need to have a supportive, knowledgeable pediatrician who is willing to
consider alternative feeding methods in the likelihood that your baby does
not gain well, and you will need someone experienced in using those methods
(cup, syringe, supplementing at the breast, etc.) Some babies will do OK
just breastfeeding, but most will need some supplementation. The main
questions will be "how much," "what fluid" and "how delivered?"
Do your homework...you have plenty of time. Your baby will be grateful for
whatever effort you put into this venture.
-Gabrielle
LLL Leader in NY
====
I was very adamant about breastfeeding although I had breast reduction
surgery prior to getting pregnant. After a failed attempt at breastfeeding
my first child, I got lots of support and managed to breastfeed my second
with the help of an SNS (supplemental nutrition system).
Take advantage of your local La Leche Leauge and/or lactation consultant.
Your lactation consultant will have a special scale that can weigh your
baby before and after breastfeeding if you are concerned about your output.
Fenugreek also helps increase milk supply.
However, with breast reduction surgery it is usually nerve damage that
causes breastfeeding difficulty by inhibiting the let down reflex. Even if
your let down reflex is damaged you can still have a great breastfeeding
experience by using an SNS.
-Amy
====
Find out how the surgery was done. If the incisions were made from the
nipple back, fewer milk ducts are cut than if you were cut around the
areola. But a very experienced lactation consultant in my area reminds her
moms that milk ducts form during pregnancy and in the early days of
breastfeeding and you never can tell just how resilient the tissue will be.
Give it a shot and keep in contact with a La Leche League Leader or
lactation consultant.
As for the inverted nipples, that also can be overcome. Try drawing out the
nipple with a breast pump or try nipple rolling as described in the
Breastfeeding Answer Book (also LLL). If you can't get them to evert, don't
worry too much. The baby is good at everting them and as that lactation
consultant says, "babies don't nipple-feed, they breastfeed."
Set up your network of support before the baby is born, in expectation of
some hard work the first few days. It's worth it!!
-Anon.
====
Did you just have fatty tissue removed? If your incision was low, you have
a great chance of breastfeeding successfully. If your nipples were removed
and reattached, you may not be able to breastfeed. Inverted nipples: begin
now to evert them. Gently roll them between your fingers and/or wear breast
shields. Check with your midwife concerning wearing them in late pregnancy,
as the stimulation can sometimes hasten labor (not so great if you're only
35 weeks!) You can accomplish the same thing using a breast pump, but it's
much less comfortable. I would urge you to visit a lactation consultant. In
many cases, these visits are covered by insurance. Or, check with your
local WIC office--a lot of them have LCs on staff.
-Amanda B.
====
Reprinted from Midwifery Today E-News (Vol 2 Issue 19 May 12, 2000)
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