Breastfeeding after Reduction Surgery

I remember it well, my consultation for breast reduction surgery. It was 11 years ago. I was 22 and in my last year of university. In the four years that I'd been at university my bra size had gone from a comfortable C-cup to a FFF (what I lovingly refer to as "Holy F--- that's big!") I was pretty miserable, although not as bad as some people I've heard about. I knew I wanted that surgery, though. The last bra I'd bought had cost $120. My back hurt and my shoulders slouched.

It was fairly quick, as we discussed how the surgery works, what a reasonable expectation was for post-surgery size and when the surgery could be done. Then there was about a thirty second discussion. "Is there any chance I'll be able to breastfeed?"

"Oh, about 50/50, I suppose," he said. "We don't remove the nipple anymore, so that helps."

"Okay," I said.

That was it. At the time I thought it was no big deal if I couldn't breastfeed, but I was sure that I would be one of the ones who could. Then almost exactly 2 years after my surger we had our first baby. During the pregnancy I talked about the surgery with my midwives and asked if I should be talking to a lactation consultant before the baby arrived so that I'd know how to handle things. No, I was told, just wait and see. Well all right, then.

Baby arrived, ended up as an unexpected c-section because she turned breech at the last minute. I was given a morphine pump afterwards for pain. I remember almost nothing of my baby's first 24 hours, until a nurse finally said to me "Are you ever going to try and feed that baby?" I don't think I even knew what day it was, truthfully. But she took baby in one hand, my boob in the other, and shoved them together, and there it was. Baby was breastfeeding. Except that didn't last long. The nurses started to freak out over my breast reduction. It was a small rural hospital. I don't know if that was the issue or not, but I don't think there was a lactation consultant on staff at all. They insisted that I needed to supplement with a tube at breast. This was less than 48 hours after birth. My milk, however much I was going to have, hadn't even come in yet and they decided that it was more important to supplement than it was to let me get the hang of latching on.

Trying to maneuver the tube while getting a baby to latch on, all while dealing with the pain of major surgery was just plain frustrating. The day came that we were to go home and the nurse tried to tell me I needed to stay another day so that they were confident I could feed her. I just wanted to go home by this point. I was hormonal and lonely and tired of being manhandled. I said "Just give me a bottle then." And that was it. When I got home and realized that my milk was coming in I immediately regretted my hasty decision, but at that point I couldn't get her to latch at all. I'd been so busy trying to keep that damned tube from falling off that I never really learned how to latch her on.

My husband heard about Dr. Jack Newman, who was then at Sick Kids with his famous breastfeeding clinic. He brought me the phone number and after working up my nerve I called. Dr. Newman called me back personally, as he's well-known for doing. He was very kind and tried to help, but I was so overwhelmed by everything I don't really even remember what he told me. I just couldn't deal with it. So our first was completely bottlefed.

And truthfully it was fine. She was happy, healthy and we loved every minute with her. Every once in a while I would get a rude comment from someone about why I wasn't breastfeeding. I know they meant well, because "breast is best", but despite my bravado about it, it cut deep.

By the time I was pregnant with my second I decided to look into the issue more. i found a book called Defining Your Own Success: Breastfeeding After Breast Reduction Surgery" by Diana West. I devoured it. I read about herbs, Domperidone, pumping to increase supply... all the things that no one told me about before. Plus, I learned that there was NO need to supplement immediately after birth since Baby is supposed to exist on minute amounts of collostrum until mom's milk comes in. No one (at least no one that I know) gives birth and has milk flooding out of their breasts a few minutes after birth.

So I went in to the hospital prepared for my VBAC, armed with my new knowledge (even with the book in my bag in case of any questions from the nurses). 24 hours later I'd had my second c-section (that's another story for another time). I'd asked to nurse her as soon as I was in the recovery room. She latched on beautifully (although the nurse had to do it for me) and everything was just find, until the anesthetic made me throw up and my husband had to take the baby while I hung my head over a basin.

I told them I didn't want to supplement immediately. Then she started losing weight, like all babies do after birth, and somehow this became an issue. I HAD to supplement. I was risking starving my baby if I didn't. She wasn't getting her tongue moving properly, and I needed to finger feed her until she figured it out. Then the lactation consultant (different hospital) came in and made me cry. It was horrible.

But I persevered. I ended up at the hospital's lactation clinic after we went home, eventually crying again, but this time with a much nicer LC. I had the Domperidone and I got Blessed Thistle and Fenugreek. I pumped as often as I could stand and my supply still just wasn't enough. She told me that there was no reason I had to stop breastfeeding. I could breastfeed, then give her a bottle. Just nursing because we both wanted to. So that's what we did. Except then we both ended up with thrush from antibiotics I had to take for an infection a few weeks later. But it lasted twelve weeks, and although it wasn't long, and I didn't exclusively breastfeed, it still felt like an accomplishment.

Baby #3 arrived. I was NOT going to be bullied again, and I wasn't. Apparently in the 13 months since Baby #2 the nurses had training on breastfeeding and they were told that there weren't to discourage a mom from breastfeeding, no matter what (or at least that's what the bitter nurse told me). So when it seemed like he wanted to nurse 24/7 and still wasn't happy, and I decided I needed to supplement, THEY were the ones trying to discourage me. We ended up "comfort nursing" again, but this time it went longer. Often when he was upset, nursing was the only thing that would calm him down. It lasted 14 weeks.

I wish I could say that things magically changed with Baby #4. Unfortunately with three other kids to look after I just didn't have the time or energy to commit to keeping my supply up properly. It only lasted 7 weeks.

It makes me sad that I was never able to do it, but at the same time I'm glad that I didn't completely give up, either. There are a lot of people who ARE able to do it, though, so the whole point of this post is that moms who have had breast surgery should NOT give up. Educate and make the decision for yourself! Decide what options will work for you and your family. I had a terrible experience with tube feeding, but so many people have great experience with Supplemental Nursing Systems like this.

A lot of people also are able to boost their milk supply with herbs such as Blessed Thistle and Fenugreek, or with a prescription for Domperidone (unfortunately not available in the US).

One of the best online resources for BFAR is at http://www.bfar.org/ It's where I originally found my book and information and I strongly recommend you check it out if BFAR is something you want to try.