Breastfeeding After Breast Surgery (Part 1)
As with surgery in any part of the body, surgery on the breast should be undertaken only if necessary and only if other tests (ultrasound, MRI, for example) or treatment have not been helpful in defining or solving with the problem. Unfortunately, many surgeons, even women surgeons, seem to be imbued with an adolescent thinking about breasts; that is, that breasts are for male titillation (sorry) and for sexual purposes only. Many seem to be completely unaware that breasts primary reason for being is for feeding babies and toddlers and for comforting and snuggling them. More than one part of the body can have a sexual side and another side. The mouth, for example, allows us to eat so we feed our body and to kiss to show affection.
No other part of the body is looked upon in the same way, where surgery would actually make that part less able to fulfill its function. If surgery on the nose, say, resulted in most cases in a person not being able to breathe through the nose that surgery would be strongly discouraged by medical regulatory bodies. But surgery on the breast does not seem to be governed by the same restraint. Once again, in affluent societies, breastfeeding is not seen as essential, but, at best, as “nice but not necessary”.
Watch this baby at the breast. The mother in this video has had a breast reduction surgery. This video also contains a video of a baby drinking extremely well at the breast. Decide whether the first baby is getting enough milk from the breast. You can find the answer at the end of this blog.
Breast surgery done usually before having babies (Breast reduction, breast augmentation surgery)
I will not discuss why women might want such surgery, but I think it is fair to say that most, but not all, such surgery is done before a woman has had children. Indeed, if I can judge from our own patients at the International Breastfeeding Centre, most of the time, the woman having surgery is as young as 14 years old, but usually 16 or 17 years old, and has not even dreamed of children in her future yet. And, in our society, may not know yet either, like the surgeon, that breasts are for feeding and comforting babies and toddlers.
It is worth knowing that any surgery on the breast with an incision done around the areola diminishes the mother’s ability to produce milk and therefore should be avoided. The more complete the incision, the more the surgery interferes with milk production. This decrease in ability to produce milk probably has little to do with the amount of breast tissue that is removed since the decrease also occurs when the incision is done for a biopsy, for example, where neither significant amounts of breast tissue is removed nor anything (a “prosthesis”) is added.
Some mothers attending our clinic have been able to breastfeed exclusively after breast reduction, even with complete incisions around the areola, but they are definitely in the minority. However, a few years ago, we did follow a mother who had had breast reduction and, with our help, was able to breastfeed twins exclusively for 6 months and then continued breastfeeding with added solids.
Unfortunately, when I ask mothers who have had breast reduction surgery what the surgeons told them regarding breastfeeding if they had this surgery, the surgeon answered one of two things, both incorrect. Either there would be no problem with breastfeeding, clearly wrong in most cases, or that the chances of breastfeeding are 50%, which, if one thinks about it, makes no sense. In fact, the mother should be able to breastfeed. She may have to supplement the baby, preferably with a lactation aid at the breast, but she can breastfeed.
What should the surgeon say to the woman asking for breast reduction surgery? That the chances that she will be able to breastfeed her babies exclusively are low. And if this woman is 16 or 17 years old, maybe it’s better to wait a couple of years, because the surgery cannot be undone, and perhaps in a couple of years she may have a different outlook on life.
If breast augmentation is done with an incision near the chest wall and the prosthesis placed there, no difficulties with breastfeeding seem to occur because of this type of surgery. However, for some reason I can only classify as bizarre, some surgeons do incisions around the areola. If the incision is around the areola, then milk production will be compromised. There can be only two reasons that I can understand for doing an incision around the areola for breast augmentation. Either the surgeon does not know this may negatively affect breastfeeding, and if this is the case, then how can the surgeon be operating on a gland s/he does not know anything about? Or, the surgeon does not care that breastfeeding will be negatively impacted. Basically, “breastfeeding is nice, but not necessary”.
Continue reading about surgery done on the breast at a time when the mother is breastfeeding a baby and when she finds a lump in her breast.
Need help with breastfeeding? Book an appointment with our clinic.
SOLUTION to the video: This baby is getting a fair amount of milk from the breast, but as the other breast is producing less milk the baby is not getting enough from the breast and the mother needed to supplement the baby, with a lactation aid at the breast (production of milk from both breasts is frequently unequal after breast reduction). You can learn how to tell whether a baby is getting milk from the breast or not by watching more of our videos and reading the explanatory texts which discuss the pause in the chin.
Copyright: Jack Newman, MD, FRCPC, 2017