Breastfeeding After Breast Surgery (Part 1)
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 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. I do not include all surgeons, of course. Some are sensitive to the function of the breast, which is to feed babies and toddlers. But many seem to be completely unaware that the primary reason for the existence of breasts is for feeding babies and toddlers and for comforting and snuggling them. More than one part of the body can have a sexual side as well as another side. The mouth, for example, allows us to eat in order to 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 a particular surgical technique 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 and even condemned 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 breast reduction surgery. The second part of the video also shows another 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)
We will not discuss why women might want such surgery, but we think it is fair to say that most, but not all, such surgery is done before a woman has had children. Indeed, if we 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 breastfeeding is obviously not part of her thinking. And, in our society, that young woman may not know yet either, like the surgeon, that breasts are for feeding and comforting babies and toddlers.
This decrease in the mother’s 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 periareolar incision is done for a biopsy, for example, where neither a significant amount of breast tissue is removed nor, in other types of surgery, where something (a “prosthesis”) is added.
We are making a plea that any surgery on the breast should be made with the purpose of the breast, that is, nourishing babies and toddlers, be always kept in mind. We believe that the vast majority of surgeons never learned how the lactating breast is different and that surgery should be tailored to the function of the breast. Furthermore, even if a young woman is not breastfeeding at the time of surgery, it is possible, even likely, that sometime in the future, she will be breastfeeding, and this too, needs to be considered when operating.
This incision was done for a biopsy of a lump in the breast. It is very long, and is follows the line between the areola and the breast itself. This incision is very likely to interfere with milk production. It is extremely likely that the biopsy could have been done differently.
This incision for a breast abscess is more likely to to cut several ducts and healing is likely to be delayed as the weight of the breast keeps the incision open. The black line indicates a better incision. It is less likely to cut ducts and the weight of the breast is likely to help heal the incision by keeping the edges close. However, surgery for an abscess is not as good as catheter drainage.
In our experience, most women having had breast reduction surgery are unable to produce enough milk, at least with the surgery done with the incision done around the areola. Some surgeons have apparently done breast reduction without this type of incision, but I am not aware of any mothers attending our clinic who have had breast reduction surgery done without an incision around the areola.
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 food to the babies’ diet.
Unfortunately, when we ask mothers who have had breast reduction surgery what the surgeons told them regarding breastfeeding if they were to go ahead with this type of 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, keeping in mind that breastfeeding is much more than breastmilk.
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 few years, because the surgery cannot be undone, and perhaps in a couple of years she may have a different outlook on life. And if she decides to have the surgery, then get good help and advice about breastfeeding when she is pregnant, so that problems can be avoided as much as possible.
Breast augmentation
If breast augmentation is done with an incision near the chest wall and the prosthesis placed there, no difficulties with breastfeeding seem to occur, at least not from the surgery itself. However, for some reason I can only classify as bizarre, some surgeons do incisions around the areola even for breast augmentation. 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: The first baby shown in the video is getting a fair amount of milk from the breast, but the baby drank even less well on the other breast (not shown in this video). As a result, the total intake of breastmilk was less milk than the baby required, and the mother needed to supplement the baby, with a lactation aid at the breast (production of milk from both breasts is frequently very unequal after breast reduction, sometimes even if the mother has not had surgery). 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.
If you need help with breastfeeding, make an appointment at our clinic.
Copyright: Jack Newman, MD, FRCPC, Andrea Polokova, 2017, 2018, 2020