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Ten Facts No One Told You about Breastfeeding after Breast Reduction

Internationally, about a half-million women have breast reduction surgery each year. That’s the first fact. But what facts do you need to know about breastfeeding after breast reduction surgery?

1. It’s possible to breastfeed after having had breast reduction surgery

A decade or two ago, many women were unable to breastfeed after their breast reductions. But today, with surgeons using techniques that preserve the function of lactation-related structures, it’s highly likely you’ll be able to breastfeed.

2. Your breasts WILL return to their pre-pregnancy size

Whoa. Hear me out. All women can expect larger breasts during pregnancy. Due to the influence of estrogen and other pregnancy hormones, breast tissue enlarges. Simply stated, that means that pregnancy — not breastfeeding — will make your breasts larger.

However, many or most women — whether they’ve had reduction surgery or not — will find that their breasts will return to their pre-pregnant size after they wean. 

3. The breast ducts can undergo recannualization

Often, the ducts — the “transport system” for milk — are severed during breast reduction surgery. However, there is good evidence that some of these ducts reconnect to one another, or some new transport pathways develop. Think of this as being similar to “collateral circulation” that cardiac patients develop. Sure, it’s a little different, but the main idea is that the body develops a natural bypass around the injured tissue.

How much recannulization will occur? That depends on a number of factors, but it seems that the act of lactating triggers the body to create these alternative “routes” for transporting the milk. Hence, a mother breastfeeding post-breast reduction might have a low supply when nursing her first baby, but she has a better supply with her next baby.

4. The nerves can become regenerated

The 4th intercostal nerve signals the brain to release oxytocin and prolactin. If this nerve is severed, milk ejection (“let-down”) will not occur. Unlike the situation with ductal recannulization, lactation does not influence nerve.

While most nerve damage recovers within six months to a year, it can take up to two years for nerves to regenerate. (You can read more about nerve repair and regeneration.) And, sometimes, the nerves never regenerate.

5. You can increase your milk supply

In all mothers, milk-making depends on a positive feedback loop. By this, I mean that the more you remove milk, the more your breasts will refill with milk. Basically, with positive feedback loops, the idea is, “the more, the merrier.”

There is a caveat to this. The average woman has about nine ducts. However, some women have as few as four ducts. Obviously, women who have fewer ducts to begin with are more affected by having even one duct severed during the surgery.

Remember, too, that just like any other woman, it’s possible you aren’t making enough milk for some other yet-unidentified reason.

6. It’s likely that you’ll experience your milk “coming in”

Although all mothers have colostrum at the time of birth, at about 3 or so days, their milk “comes in.” So, you may find that your breasts feel full around that time. Having your milk “come in” is a good thing! Engorgement is normal, and desirable.

7. Your past surgery is not “causing” engorgement

Hormones cause the milk to come in. If your hormones are working properly and your lobes are intact, your milk will “come in” whether you breastfeed or formula-feed; whether you have had breast surgery, or not.

But if you’re breastfeeding after breast reduction surgery, you may notice that:

  • part of one breast is more engorged, and part remains soft
  • you have more engorgement on one side than on the other side
  • your discomfort with engorgement is likely to increase each time you have a baby

Some moms worry that the discomfort indicates a plugged duct. That’s certainly possible. But more often than not, natural engorgement causes the discomfort. Discomfort will subside.

8. The type of incision used for your surgery might affect your breastfeeding experience

Might.

A recent systematic review by Kraut and colleagues was encouraging. They concluded that “Techniques that preserve the column of subareolar parenchyma appear to have a greater likelihood of successful breastfeeding.” (The subareola parenchyma is the lactating part of the gland just under the areola) So in the initial consultation, it’s important to emphasize to the surgeon that you want to maximize your chances for breastfeeding.  

If you’ve already had the surgery where the surgeon used techniques associated with a lesser likelihood of success, take heart. Breastfeeding after breast reduction surgery is often still possible.  

9. One breast may produce more than the other

Even among women who have not had breast surgery, sometimes one breast produces more milk than the other. Such a difference, if not too dramatic, can be entirely normal — or at least common. 

The real question is, do you have enough milk from both sides to support the baby’s growth and well-being?

10. Multiple techniques help to improve milk supply

It’s entirely possible that you won’t have a full milk supply. You may need to supplement. But there are techniques to help you improve your milk supply.

These days, most mothers turn to the internet and social media for “advice” about milk production. Does this advice work? We can talk about that later, but bottom line is this: NOTHING substitutes for frequent stimulation, and skin-to-skin contact.

Stay tuned for a future post about breastfeeding and breast enhancements!

Can you share a story about successful breastfeeding after breast reduction surgery? Use the comments section below!  

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56 Comments

  1. Emilia

    I had breast reduction surgery 11 years ago when I was 18 years old. Four months ago I gave birth to out first child. I was worried about breast feeding as my nipples are very low after the surgery and are not as sensitive as they used to be before the surgery. Unfortunately I had to have a c section and I lost a lot of blood. So it was unsure was my milk supply big enough and we were told to give our baby some extra formula. However, in 2 weeks the baby had grown so quickly that we could stop giving formula. During the first 2 months our baby grew 500g every 2 weeks. When he turned 3 months the growth slowed down, 500g per month. At 4 months he is still fully breast fed but I find difficulties with milk let down. For some reason I am unable to pump milk. Even when I breastfeed on the other breast, I only het very small amounts to the pump. I am still happy that I have managed to feed my baby regardless of the surgery.

    • Marie Biancuzzo

      Good for you that you that you’ve done so well, even though you had your reduction surgery. And, for baby, that first month, they have weight gains of approximately 1 ounce (about 28 grams) each day. Sounds to me like you’ve done a remarkable job nursing your baby!

      • Keri

        I’m just curious if you usually struggle with a BIIIG over supply would getting a reduction (want one anyways) help if you ended up having another baby after surgery?

        • Marie Biancuzzo

          As far as I know, we don’t have any evidence to support or refute that. However, I doubt that there is much, if any, relationship. Large breasts aren’t necessarily about more milk-making apparatus. (The “working” part of the gland.) Rather, breast size is more related to the non-working part of the mammary gland. That being said, certainly, the breast surgery can—depending on how it was done—impede anyone’s supply. Does that make sense?

  2. RD

    I had breast reduction surgery 18 years ago at the age of 22. I had the “anchor” method or “lollipop” incision surgery whereas they left the nipple connected to the milk ducts and glands and just repositioned it.

    I just gave birth to our first child almost 9 weeks ago. I had a vaginal delivery but since I have been experiencing a lot of stress and anxiety and my baby has been colicky and refluxing, I have not had the time to dedicate to really pump. I probably pump only once or twice a day, if at all.

    I have been using supplements such as lactation tea, lactation cookies and bars, fenugreek pills, Brewer’s yeast powder, and protein powder. Due to my inconsistency with pumping regularly and eating and drinking enough, I have unfortunately only been able to produce about 3 ounces total at the very most in one session.

    Although I still breastfeed every 3 hours around the clock with the exception of nighttime, I have had to supplement our son with formula. I give him about 3 ounces every 3 hours. I subtract from that if I have expressed breast milk (ie. 2 ounces of expressed breast milk and 1 ounce of formula to equal 3 ounces).

    He currently weighs 12 lbs 1.5 ounces so he’s in the 44th percentile. So, he’s growing well but I still would have loved to exclusively breastfeed.

    • Marie Biancuzzo

      I hear so much success in your story! You are nursing your son every 3 hours. That takes a lot of focus, and a lot of commitment. I’m gathering that, based on his birthweight, his doctor is happy with his weight gains, so kudos to you for making that happen! Good that you’ve recognized that none of those foods, drinks or supplements are a substitute for frequent breast stimulation; I’d encourage you to look for opportunities to increase your nighttime feeding. I’d venture to say that many mothers—with or without the breast surgery—have not given their baby as much of their milk as you have, and for as many weeks. I hear you on the wish for exclusive breastfeeding, but honestly, every public health authority I know says that “some” breastfeeding is better than none. Few of us can accomplish all of our endeavors to the max. Give yourself credit for making the best choice, overcoming some 18-year old obstacles, and growing a healthy child!

  3. RD

    Thank you so much for your words of encouragement! You are so kind.

    His birth weight was 7 lbs 3 oz so the doctors are happy with his weight gain.

    I only breastfeed maybe once or twice during the night (before every nighttime feeding) so I will try to do it more. He eats about every 4-5 hours during the night as opposed to every 3 hours.

  4. Fallon

    I had implants removed and was talked into a lift as well. They said they left the areola mound alone but I have doubts.
    I wind my son at 21 months a month prior to surgery. That was coming up on two years ago just over 18 months when I delivered my second child in October. I have always been able to hand express small amounts of sticky stuff ever since it was comfortable to try after surgery all the way up until I delivered her. she nursed round the clock after birth which can be normal and was having adequate wet but out of-month-old we discovered she was barely at her birthweight and that explained all of the crying unless she was with me, usually nursing. It has really affected our bond. Like the first commentor I cannot seem to pump with an electric pump. I get less than a half ounce from the pump combined but can get as much is an ounce if I hand express. This keep in mind, is after over a month, almost 6 weeks of ineffective nursing ruining my supply. Now I Have started expressing every 1-3hrs to try re-lactating to get to a point where I can maybe even meet her demands fully. Currently we supplement with the SNS about 90% donor milk, and whatever she gets from my breast if anything.
    This has been the worst best 6 weeks of my life. I wouldn’t wish low supply with the inability to pump on anyone. I don’t regret anything in life…until now. Man oh man I wish I had never let the surgeon pressure me into a lift.

    • Marie Biancuzzo

      Oh, Fallon, I can almost see the tears pricking at the back of your eyes! However, your last two lines loudly say “regret” and I just hope that you’re not blaming yourself. It seems to me like you made the best decision you could, given the information you had. Trouble is, I’m betting you didn’t have (a) enough information and (b) correct information. The “preserve the areolar mound” may or may not explain your issues. The real question is, was there a severing of the 4th intercostal nerve which is critical for breastfeeding. The number of wet diapers is worth noting, but honestly, not very helpful in determining whether your baby was getting enough milk. Someone should have told you that stools in the first month of life are a much better indicator of adequate milk intake. Someone also should have reminded you that even the best pump in the world cannot give the stimulation that the baby gives. So pumping not a “bad” idea, but I’m just saying, it’s never “the same”, especially in compromised circumstances. The professionals who were assigned to your care during the hospital stay, and the first several weeks after, should have initiated follow-up, since anyone with previous breast surgery is at risk for not achieving a full supply. (Some do, some don’t.) I applaud you for your continued efforts for your daughter. Keep doing what you’re doing, but make sure you have a way to monitor her weight gains. (At this point, number of stools is not as helpful of an indicator as it would have been during the first month.) I still hold hope that you might make more milk (it sounds like you’ve got some good strategies going) but I don’t know your whole history and surgical details. Remember, however, that there are many reasons for low milk supply, and it might not have anything to do with your surgery. I’d urge you to get professional help. Meanwhile, kudos to you for continuing to achieve your goal!

  5. TD

    I had a breast reduction about 13 years ago and wasn’t sure I would be able to breastfeed. Fast forward 4 years I had my 1st child and was hoping to breastfeed her. We had latching issues but I was able to pump. I was actually producing 4 times the amount she needed but ended up giving up at about 4 months because my breastmilk made her so gassy and uncomfortable. 5 years later I had my twins and the exact same thing happened. I made more than enough milk, through pumping, for both of them but had to stop for the same reason. Now I have my 4th child, born 7 weeks ago and currently experiencing the same thing. He is not a cry baby..but is so gassy and uncomfortable after feeds. In all three cases I tried eliminating dairy and other things from my diet without any success. I am even beginning to wonder if the surgery could have affected the constituent of my milk, or maybe I am just being paranoid. The good thing is my kids all gain well on the breastmilk, but the sleeping issues from being so uncomfortable seems to be the issue. Right now I have a freezer filling up with breastmilk and I am at my wits end trying to figure out why it makes them so gassy and grippy.

    • Marie Biancuzzo

      This jumped right out at me, immediately. You need to see a lactation consultant who has had experiencing managing cases of lactose OVERLOAD. Do not confuse this with lactose “intolerance” which is an entirely different phenomenon. (But people often say that, because they just don’t know what’s talking about.) I’m sitting hundreds of miles away from you and I haven’t seen you or your baby and most certainly this is NOT medical advice, but I am urging you to seek individual help for lactose OVERLOAD because the signs and symptoms you are reporting seem to align with that. (And no, modifying your diet will not help. It has nothing to do with the mother’s diet.) Thanks for writing, I hope this helps.

        • Marie Biancuzzo

          Hi Debbie. Where are you seeing “lactation overload”? I’m not seeing it in this post, and I hope you’re not seeing it in any of my posts! There is no such a thing. I suspect you are asking about “lactose overload” and it refers to a situation where the baby is getting a disproportionate amount of lactose, compared to carbohydrate and fat. It often happens with a very high milk supply.

          • JG

            It says lactation OVERLOAD twice in your reply from 12/13/19 at 8:43am, once it’s even in bold. I was going to ask the same thing because I had never heard of that before.

          • Marie Biancuzzo

            Oh, wow, good eye, good eye! When you said “in your reply” I could immediately find it. Okay, this was either me with bad typing, or it was the electronic spelling gods trying to “help” me! Thank you for your good observation. I believe I have fixed it now. Thanks!

  6. Nthomeng

    I have a 16 year old with enormous bust. Is breast reduction advisable at her age. She has back problem due to the size of her bust. He self esteem is low due to this

    • Marie Biancuzzo

      Oh, my. This is a tough question to answer. When you say, “advisable”, I’m wondering, since my post was about breastfeeding, if you’re asking about the impact of reduction surgery on breastfeeding. Honestly, the “advisable” part depends on the pros and cons to the entire situation. First, breastfeeding reduction surgery is fairly pricey here in the US (I see you’re in the UK.) Check it out. Second, if she is having back problems, neck problems, etc. etc., that’s a big factor to consider; what are the consequences of not having the surgery. If you can prove “medical need”, you might be able to get insurance to pay for at least some of the fee. (Again, I’m totally ignorant of how this would work in the UK, but…) I’d also wonder if she is overweight in general. For some but not all women, breast size is due to fatty tissue. If so, a weight-loss program might present some advantages without some of the consequences. At least here in the US, some girls do get the reduction before age 18 (so it’s legal) but many surgeons are very reluctant to do it before age 18. I doubt that any surgeon would “guarantee” that she could exclusively breastfeed after the procedure. But she might be able to partially breastfeed. (And some women report not being able to breastfeed at all.) I’m not a physician or a surgeon, so this is not medical advice. And, just as importantly, I’m entirely ignorant of the financial and legal implications in the UK. I would strongly urge you and your 16-year old to ask a lot of questions before signing up for the procedure. Meanwhile…UK readers, can you help with the legal and financial implications here?

      • A Le Grange

        IBCLC and BFAR Mum from the UK here. Breast reduction is available in some cases on the NHS – there are strict requirements including having a normal BMI, having sought other avenues for the back issues and needing at least 500g to be removed from each breast. It is not covered by any private health insurance company but fully-paid private options are available.
        At 16 breasts have not always fully developed so I’m not sure that any surgeon would carry out the surgery at that age. The decision about breastfeeding is a big one as most people who have had a breast reduction cannot exclusively breastfeed their 1st baby- but most can produce some milk. It’s unlikely your daughter has any idea right now on what her desire to breastfeed would be if she were to become a parent in the future. Good luck with your research.

        • Marie Biancuzzo

          Anna, thank you for letting us know about coverage for this surgery in the UK. (I didn’t have a clue.) And I totally agree; a 16-year old really doesn’t have any idea about the parenting aspect. (Trouble is, at least here in the US, many have the surgery around college age.) We can only offer guidance in the meanwhile. Thank you for your insight.

      • Lauren

        I was reduced at age 16 and in the US. I don’t remember the financials, but I think after insurance it was $500? Again, I vaguely recall the number being discussed, never saw the statement.

        My mom was in customs sizes (K?) after breastfeeding me and my sister and I already had DDD at 16. I was overweight (160-170?) at that age, but my breasts were still disproportionate, nipples pointed straight down, and I was experiencing lots of back pain, not to mention that I played baritone horn in marching band, the heaviest instrument to carry with just your arms.

        I’m pregnant with my first and hoping to breastfeed. I feel every aspect of what your daughter is going through. For me, it made a huge difference in my pain and my self-esteem. It made it so much easier to exercise and keep my weight down as well. As someone who went through it before her, I say go for it. But definitely follow the advice here and find a surgeon who can leave the tissues as intact as possible for breastfeeding.

        • Marie Biancuzzo

          Oh Lauren, what a great story. Thank you for sharing and helping us all to understand something that we might not otherwise realize.

    • Emily

      I had surgery in Finland when I was 19 (It took so long because of the bureaucracy as the operation was fully covered by the Finnish health care system) but started the process when I was 17 as my mother encouraged me to go to the doctor to speak about the problem. It changed my life completely. I could play sport, wear normal clothes, didn’t have old men whistling etc. I got to be a normal girl and I got my self-esteem back and I am forever grateful for my mother for understanding the effect the breasts had on my self esteem. I had 700g per breast reduced, so 1,4kg and I had a normal BMI. I don’t think I could have gone through the process without her support. I agree that even at the age of 19 I could not think how important nursing my baby would be in the future, but on the other hand because I had the surgery when I was young, my breasts had healed well and when I had my baby at the age of 30, I was able to fully breastfeed my baby. But even though I could not have breastfeeded, I am happy I had the surgery because I believe that a healthy and happy mother also benefits the baby. Every person is different and I can only tell you my experience but I believe that providing your daughter with the right information and support her with her decisions, that is the best way to go. It is her body after all and therefore her decision 🙂

      • Marie Biancuzzo

        Emily, thank you for sharing your story. It sounds like you had a positive experience, and you have no regrets even now that many years have passed.

    • Morgan

      I had a breast reduction at 16. (I’m 29 now with an almost 4 month old now!) It was the best thing I ever did besides having my baby. But breastfeeding is HARD and he gets most of his milk from donor. I am on domperidone and have taken every herb, tried every pump, taken every brewers yeasty oatmealy thing the whole time and it’s still a struggle. But still… don’t regret it.

      • Marie Biancuzzo

        It’s always great when we can walk away from something with no regrets. Yes, “things” are often hard, no matter what decision we make or don’t make. You admit that breastfeeding has been hard, but you still don’t regret your decision for a reduction. I applaud you for your honesty with yourself (and now, with everyone reading this!). Good for you, you go, girl!

      • Lauren

        Morgan, we have nearly the same story! I’m 29, reduced at 16 and pregnant with my first now. I expect my breastfeeding journey will be difficult but it is encouraging to know that it is possible!

    • Molly

      Hi, I had a breast reduction when I was 16 so I thought I’d throw in my two cents.

      For me personally the sexual harassment I began experiencing around age 12/13 was a bigger issue than my back pain, however I do have so much back pain now that I can’t even begin to imagine how bad it would be if I hadn’t had the surgery when I did. I played soccer and basketball, and there weren’t enough bras in the world I could wear to hold my boobs in place. I typically wore three. And to speak to what Marie said, my surgeon was reluctant due to my age and originally tried to tell my mom over the phone I probably needed to just lose weight. After meeting me and seeing I weighed literally 125 pounds with 34 GG breasts, he decided he would do the surgery. He did ask me a lot of questions to judge my emotional maturity and that factored into his decision. Also our insurance didn’t cover a single penny because they considered it a cosmetic procedure.

      My surgeon counseled me on the possibility that I wouldn’t be able to breastfeed. I am 27 now, getting closer to the point where I’d like to start having children, and I’m on this thread reading because of the concern I have about being able to breastfeed or not. At that age I said I didn’t care one bit if I could or not, and now I am a lot more conscious of how big of a decision that was. I still wouldn’t change anything as I was so miserable, but I absolutely would’ve had more questions about the type of surgery for the sake of preserving a better chance at being able to breastfeed. I don’t know what the name for my style of surgery was, but it was the keyhole shape for cutting out the excess tissue. I know my nipples were completely removed and relocated, so my ducts were absolutely disconnected. I personally didn’t know the information about the specific nerve that is important for let down, so that’s probably the next thing I’ll start researching about it’s theoretical regeneration.

      I hope this helps!!

      • Marie Biancuzzo

        Whew! Molly, what a story! Honestly, I don’t want to discourage you from reading more information, but I don’t think you’re going to find the answer on the web or even in a book about how it’s all going to transpire for you and your baby. I doubt you’ll get the entire answer to your question until you put your baby to breast. True, I’m uneasy about the fact that the nipples were removed and relocated, but try not feel completely defeated.

        That said, if you’re looking for information, the two best resources I know are my podcast with Diana West (who had breast surgery herself in the days when the techniques weren’t nearly as good as they are now) and also, her book.

        Whatever you do, don’t beat yourself up for having the surgery. It sounds to me like you made the best decision you could with the information you had. (And frankly, even after all of these years, you still don’t have much more information on the breastfeeding outcomes!) As I hear you talking, you sound as if you were tired of the verbal taunts, the back pain, the limitations of playing soccer etc., and the general discomfort that goes with inadequate support. Seriously, you don’t want those problems ever again, right? If you’re waiting for someone to say “tsk, tsk, see what’ve done to yourself” you’re not going to hear that from me! (And you most certainly you should not hear that from yourself!) I think you showed a lot of courage for trying to put yourself in a better space at a very young age.

        I realize you don’t have the baby here yet, but I promise I’ll still be here when that happens, so be sure to let me know what happens in that next chapter!

  7. Courtney Julien

    I had a breast reduction about 5 years ago. I just gave birth to my first baby, Evelyn, 4 1/2 months ago. I asked the surgeon if I would be able to breast feed and he told me that there would be no reason why I wouldn’t. I wish he had been more honest with me about my odds being lower than your average woman.. but then again I was so determined to get this reduction that it may not have changed my mind; especially since I didn’t know the power of a mothers love at the time. After surgery, my right areola turned partially purple and scabbed up really thick and eventually the scab fell off leaving a lot of awful scarring. When I questioned the doctor on the condition of my healing areola he told me to stop reading on the Internet. Fast forward until after the birth of my daughter, she was losing weight pretty fast at the hospital so I had to give her formula. It was the most devastating feeling in the world not being able to produce enough milk to feed my daughter. Combine that with my hormones and I was an absolute mess. I’m sure the awful condition of my right breast contributes to the low supply. I still continue to give her as much milk as I possibly can.. she looovvvves nursing from me! And even though I can’t give her a full supply, it is the most beautiful experience being able to feed her at all. I spend most of my time nursing her on the couch, and I pump about 4-5 times per day. I’ve noticed that I double my milk when pumping if I do a lot of firm massage, shaking, and bending over. In total I think she gets about 50% from me. The morning is the only time she gets a full feeding off of me. I’m hopeful that I will have a full supply for my next child. Any recommendations to help that happen?

    • Marie Biancuzzo

      We should all stand back and notice your passion, your determination, and your creativity in this situation. And, I’m eager to reinforce what the World Health Organization (and others) say: ANY amount of breastfeeding is better than NO breastfeeding. I’d also suggest that your baby is totally unaware what “percentage” of milk come from you, and what come from the pump. She is not counting. She is happy for everything you give her. We all have mothers. All of our mothers have been a little short on something—milk, time, education, patience, whatever. None of us have a “full supply” of everything. Congratulations on giving your daughter the best start in life.

  8. Christina

    I’m in a slightly different position than other posters- I had to stop nursing my 9 month old at 2 months due to recurrent mastitis and severe antibiotic allergies (long story). Since I stopped nursing I have had mastitis two more times. At an ultrasound in November they found a fibroadenoma in my breast that I am meeting with the surgeon about removing. I’m debating getting a reduction at that time since I’ll be under and have to go through recovery or waiting until we are done having kids (would like one more in a couple years). I’d LOVE to be able to breastfeed my next child and am partially convinced that my large breasts contributed to the mastitis bc I couldn’t ever find a properly fitting bra (34J+ while nursing). Wondering if maybe doing the reduction now would decrease my chance of mastitis and at least let me combo feed?

    • Marie Biancuzzo

      Of course, I cannot provide medical advice. And in this case, without having actually seen either your anatomy or your mastitis, I can’t provide much advice at all. However, I can prevent a few facts. Women with small breasts can and do experience mastitis, too. You should know that wearing a too-tight bra is a highly likely explanation for an episode of mastitis. Essentially, I’d like to ask you to consider that having smaller breasts won’t “prevent” mastitis, but having a well-fitting bra is one good strategy for reducing your chances of having mastitis again. You might also want to read my post on mastitis. Thank you for the comment; I hope this helps.

  9. Rachel

    I’m only 5 weeks, so very early. Back when I was…. 22? I had a breast reduction the surgeon told me that our breasts are made up of 1. Fat and 2. Milk ducts. He told me after he went in and reduced them that mine were mostly made up of milk ducts! I was above a DDD (he told me he’d try to get me to a C but I actually have a DD) I don’t have any regrets on having the surgery- I did what was best for myself at that time. But I am wondering….. will I be able to feed my baby? Is it bad that they probably removed more ducts than fat? What are some steps I can take prior to having the baby to optimize my chances at having a good milk supply?

    • Marie Biancuzzo

      Rachel, good questions. The surgeon who said the breast is made of fat and milk ducts may have over-simplified it a bit, but yeah! I agree. I usually explain it like this: There’s the working part of the mammary gland (the lobular tissue and the ductular tissue) and the other stuff (the fat, connective tissue, and so forth.) Think of the lobes as the milk-making factory. Most women are born with about 9 or 10 lobes; some have as few as 4 lobes. Think of the ducts as the “transport system” that are attached to each lobe. The milk travels out of the lobes (milk-making factory) through the ducts (transport system) to reach the baby.

      Obviously, I don’t know what your surgeon removed, but I can tell you this: Women who have more than 10 lobes (and the attached ducts) breastfeed just fine. Women who have fewer than 10 (like, maybe as few as 4) can breastfeed just fine.

      That’s a long-winded way of saying, there’s not a specific number of lobes or ducts you must have in order to successfully lactate, and women have different numbers and they do just fine.

      Try to read my post again, keeping in mind your questions about your likelihood of success. And by all means, listen to my podcast with Diana West. I think you’ll find some reassurance. No guarantees! But some reassurance.

      Let me know how it goes 8 months from now!

  10. Marie Biancuzzo

    Rachel, one more thought to perhaps ease your mind. Like the mammary gland, kidneys are also glands. (Glands are organs that produce specific substances.) Some people are born with only one kidney. Some are born with 2 kidneys, but only one that functions. And I can immediately think of a woman who was born with 4 kidneys. Yet, in most cases, plumbing works just fine for these people. I realize you are thinking about the surgical correction rather than the “born with” issue. Nonetheless, you’d be amazed at how the human body is remarkable in its ability to compensate. Have hope! Meanwhile, thank you for promising to let me know how it goes. (I’ll still be here!)

  11. Steph

    Hi Marie,
    I was 19 when I had a breast reduction, which relieved much of the uncomfortable weight on my chest, allowing me to exercise, etc. At the time I had chosen a more moderate reduction (I went down one cup size, from a DD bordering on E to a smaller D, or 1lb per breast, because I wanted to avoid the anchor scar; the surgeon used the lolli pop technique and I believe left my nipples connected to the milk ducts and glands and just repositioned it). I do wish I had chosen the more substantial reduction as I am a petite person (5’4, 110 pounds) and the D cup still feels somewhat uncomfortable and heavy on my frame. I am now 34 and my health insurance has approved a second breast reduction. My partner and I plan on having a baby when I turn 36 and of course I would like to be able to breastfeed. Do you know if there is a reduced likelihood of being able to breastfeed among women who have had more than one breast reduction surgery? Would you strongly advise waiting to have the second breast reduction until after I have a baby?
    I appreciated reading all of your thoughtful and supportive posts!
    Thanks and sincerely,
    Steph

    • Marie Biancuzzo

      Steph, I am at a loss here on what to say. I have read more scientific studies on breast reduction and subsequent breast reduction than I can count. But I don’t remember ever reading a study on someone who has had a second reduction. I would need to do a very, very deep search of the literature to even begin to give you an evidence-based answer. Otherwise, I would be completely guessing. The information, if out there, will be pretty slim. I also cannot remember interacting with any woman who has reported having a second reduction.(Notice I said “report” because women don’t always tell the whole story!)

      I want to step out of my breastfeeding persona for a moment, however. I worked Labor/delivery for years, and as I read your story, I was wondering, why you would want to wait to become pregnant after age 35. Only you can answer that. (And you certainly don’t need to answer it in a public forum like this!) I admit that I don’t really keep up with that literature the way I used to, but for as long as I can remember, the physical advantages of having a baby younger rather than older is the way to go–both in the scientific literature as well as my clinical experience. Notice i said “physical.” So you could convince me that you have social or economic or whatever reason, but from a physiologic standpoint, I’d say that delaying does not offer any physical advantage, and is likely to pose more risk. (Although not as much risk as it did in times past.)

      I’d also say, think through the pros and cons of having a baby somewhere in the “now” neighborhood, and having the second breast reduction somewhere in the “later” neighborhood.

      Think about it.

  12. Tabby

    Hi I just had a breast reduction surgery about one week ago and I have some questions that I should have asked sooner. #1. I am currently 18 and I was wondering if the amount of time after the surgery effects the amount of milk I would produce if I decide to have children in the future? #2. I went from an I cup to around a D cup, do you think the large size difference would make it less likely for me to produce milk? Again I’m only 18 right now, I personally don’t intend to have kids for a while and I’m fine if it turns out I can’t breastfeed in the future. Just trying to get a little bit of insight. Thank you for your time and any answers you can give!

    • Marie Biancuzzo

      Tabby, good questions all. And smart of you to get a bit of insight now so that you can make decisions later. Understand, this is not medical advice, and I’m not an MD, much less a surgeon! But for some general ideas to consider and some starting points for further exploration: (1) How much time has elapsed. Given what we know about the nerve regeneration (see the post), I’d say that at least some time needs to elapse. So good that you’re not in a rush to conceive. (2) Large size. Well, years ago, there was some science to support that notion but little or none that I know of now. I want to warn, however, that there are so many factors in play. Meaning, even if the time elapsed and amount of tissue removed are real factors with a real impact, there are so many other factors that affect breastfeeding and lactation success. Some of those factors relate to the surgery itself, over which you have little control. However, there are many factors as related to the basic, physiologic process of lactating.

      Consider it this way. Suppose you break you ankle bone. That ship has sailed, you can’t undo that. But, you still need strong leg muscles, good walking shoes, good posture, etc. etc. because walking is a normal physiologic process. Same for this; concentrate on what you can control, and get help for achieving your goal.

      A few final thoughts: There is strong, strong evidence that some breastfeeding is better than no breastfeeding. The importance of good nutrition, and immune protection, has lifelong effects. (This is not something that is good just for babyhood or even childhood.) You might not be able to fully lactate. Okay, then consider the lifelong impact you can have with only partial breastfeeding. Full breastfeeding, while optimal, may not be realistic for you, but you might never know until you try, and until you get help from someone who is highly skilled in helping with this situation. I’ll still be here…let me know how it goes!

  13. Ana

    Hi! Any insight would be greatly appreciated! 🙂

    I had my breast reduction at 18 in 1999. I went from a 34ddd to 34c. A “few” years later at 34 I had my daughter who is now 4 and at 35 I had my son who is 3. I wasn’t able to breastfeed my daughter but I did breastfeed my son for 6 months. It’s been 2.5 years and I can still produce milk, but what is constantly on my mind is the “full” feeling in my breasts. With my son, I would either breastfeed him or manually extract milk. The pump would not get any milk out. So now when I can’t take the full feeling any longer I manually extract a bit of milk to feel some relief. Not that much comes out- less than 0.5 ounces. Sometimes I can feel where the milk is and I apply pressure there to get the milk out. But sometimes it is too far inside and I can’t seem to get the feeling to go away. I have gone back up to a DDD cup or maybe even G now. My doctor has checked my prolactin level and I am fine. I don’t know what else to do! My breasts hurt all day and night.
    My endrocrinologist prescribed Bromocriptine Mesylete a few months ago but I was reluctant to take it. I finally pulled the trigger and have taken it the last two days. I don’t feel a difference yet.

    Is there any other advice you could give me? A support group?

    Thank you in advance!
    Ana

    • Marie Biancuzzo

      Ana, I admit, I’m stumped here. It’s not terribly unusual (okay, maybe a little unusual, but certainly not unheard of) for women to produce small amounts of milk after their baby is weaned, sometimes . But 2.5 years seems like a lot. I’d also say that it’s not terribly unusual for women to have an increase in breast size after lactation. But again, going from a C to a DDD seems like a lot. Prolactin levels are normal. The amount of milk “coming out” doesn’t seem proportionate to the amount of “fullness” you feel, or to the DDD size. This might seem a little far out there, but has someone done an ultrasound to rule out a galactocele? That seems unlikely (especially if the fullness is on both sides) but I’m otherwise out of ideas. (And you know, of course, that this is just information not medical advice, and in this case, it’s very weak information!) It just seems to me like something should explain the full feeling (subjective) and the much bigger size (objective.) Bromocriptine? Yeah, we used to use that for formula-feeding mothers, but I’ve never been convinced that it was effective, but I didn’t see the mothers for long-term follow up what I think probably doesn’t matter. Have you tried cold packs? Typically, cold packs will reduce tissue inflammation in any part of the body, and we do use it a lot for lactating women. I don’t know what to tell you. But I do believe there is some explanation for what you’re feeling/seeing, and I commend you for continuing to get an answer from a medical or surgical perspective. Something seems off to me. Honestly, I have no idea if it’s in any way related to your previous surgery, but I do know that you deserve an answer.

  14. Diane

    Hi,
    I didn’t have a breast reduction, but a breast lift anchor method 2018. I am currently pregnant 35 weeks. My last pregnancy was 10 years ago and was able to breast feed fully worn no issues. I really want to breastfeed. My nipple were slightly reduced during surgery. Will that impact the ability to nurse? My nipped have sensitivity and breasts have been sore during my pregnancy. When I try to hand express now, there’s nothing so that makes me nervous I won’t be able to. Any input would. E helpful. Thank you.

    • Marie Biancuzzo

      Diane, the fact that you have nipple sensitivity is a good sign. Very good sign! Sensitivity is highly suggestive that your 4th intercostal nerve is “working.” I would be much more concerned if you didn’t have sensitivity. You’ve said “sore” breasts during pregnancy and by that, I’m thinking tenderness. If so, that is consistent with the fact that your hormones are helping the breast tissue to make milk. A colostrum-like substance is “there” in the early 2nd trimester, but many women aren’t aware of it. And, in my experience, few women have perfected their hand-expression technique, so maybe it’s “there” and you’re just not getting what little bit is there. I don’t have any exact predictions here. I’d encourage you realize that it is what it is. You can’t go back and undo the surgery. You can’t become un-pregnant. You can’t change what has or hasn’t happened at this point. When the baby is born, if the milk-making process isn’t working as you’d planned, get professional help. But right this moment, I’m optimistic, given the information you’ve described. And I think you should be optimistic too!

  15. Diane

    Thank you Marie for your reply. I am currently now 39 weeks, and hoping for the best I will be able to nurse. With your optimistic outlook, I will try my best, and not be too hard on myself. You’re absolutely right, surgery is done and in the past. Finger cross for me I will be able to nurse her soon!

    • Marie Biancuzzo

      Diane, yes, with or without a reduction in your past life, optimism is essential! As with almost anything in life, how we think of ourselves and our abilities is a critical part of our success. Nursing a baby, getting a college degree, growing tomatoes, knitting socks…you can’t do it unless you believe you can. To quote Henry Ford: “Whether you think you can or think you can’t, you’re right.” Let me know how it goes!

  16. Ariane

    So happy I found this post and comments from mothers who have had reduction surgery! I have been searching for information on what the chances are that I might be able to successfully breastfeed and this has given me reassurance that it might be possible.

    I am 30 weeks pregnant with my first child at 39 and had reduction surgery at 19. Once my breasts reached their full size (more or less) at 16, I was miserable. I had to wear 2 sports bras for exercise, and was extremely self-conscious of how large my breasts were. I despised the men that would stare and comment in the street. I lived in France, and at the time it was impossible to find bras or bathing suits larger than a 36C in regular stores, which just made me feel that much more ashamed of my body. For me it was entirely genetic – I was only 120lbs at 5’8″ and most of the women on both sides of my family had large breasts. My mother had a breast reduction when I was a child, so when I started talking about having a reduction, she was in agreement, and it was entirely covered by insurance there.

    Breastfeeding one day was literally the last thing on my mind at that time, and I don’t recall any mention of it from the surgeon, or from my mother for that matter. I really have no idea what kind of surgery I had. And I’m a little ashamed to admit that it never even occurred to me that a reduction might lead to breastfeeding issues until I was pretty far along in my pregnancy! It was so long ago and not something I ever think about. I do remember that it took a long time for sensation to return to my nipples following my surgery (maybe a year?), and they were never quite as sensitive as they had been previously. But during pregnancy my nipples have been downright painful at certain times, so I assume that is a good sign. My breasts themselves have now gone from a 34B/C pre-pregnancy back to a 36DD, and I assume they will get even larger towards the end of my pregnancy. I can only imagine what size they would be now had I not had the reduction surgery.

    I realize there’s no way to know what the situation will be until the baby is here, so I will just try to think positive thoughts in the meantime. If I have to supplement with formula, then so be it. I remember my own mother telling me she was shocked that she couldn’t produce enough milk for me, since she was a 38DD, and she thought there was a correlation between breast size and milk production. I know I’ll get a visit from at least one lactation consultant at the birth center following the birth, but I don’t know if they’ll be knowledgeable for my particular circumstances.

    Thank you Marie for this post and to all of the women that have shared their stories!

    • Marie Biancuzzo

      Ariane, what a story! What a story! You seem to be in a good place at the moment. You’re realizing that larger breast size is not predictive of larger milk volume. You’ realizing that at 5’8″ tall and 120 pounds, you certainly weren’t “fat” by any means (!) and I’m hoping you’ve now begun to accept your breasts/body as is. (Remember, some people have big noses or pigeon-toes or buck teeth whatever, and that’s not their fault, either. We just come built the way we are.) It’s not unusual that an adolescent wouldn’t be thinking about how to feed her baby. Not on the radar at all, I’m sure. Don’t feel badly for what you thought or didn’t think, what you asked or didn’t ask at the time. Living in the past only deprives you of the joys of the present and the future.

      I feel optimistic for your mothering experience. Nowhere is it written that you “must” exclusively breastfeed, and you seem at peace with that. It appears to me that you’ve had breast enlargement during pregnancy and some distinct nipple sensation, so those are positive signs that your breasts are getting ready to (fully or partially) breastfeed your baby. Not a guarantee, but it’s a good sign!

      Yes, you’ll probably get a visit from the lactation consultant. Just remember that not all are knowledgable about breastfeeding after breast reduction, and not all are accepting of the idea that exclusive breastfeeding is the only goal. I would encourage you to bookmark this blog post, and take along Diana West’s book.

  17. Iden

    I had minimal breast tissue on the left side and a large amount on the right side. initally at 17 i got a implant which left me only able to feel pain (no other feeling) in that breast. i had my son and was able to breastfeed him for 1 year but the implant side didn’t produce as much milk (still had letdown reflex though).
    when i was 24 i got a reduction on my right side to help my breasts look more similar.
    i had my daughter 18 months later and struggled very much with breastfeeding. she didn’t like my left breast (implant one) and preffered my right but i found when i tried to hand express i got nothing out of it and with a hospital grade pump not very much at all. she was never a chunky baby and by 6 months i had to give up because she was biting to the point my nipple was half off.
    now i’m 25 weeks with baby 3 and i want to try breastfeeding again but i’m scared the side with the reduction has no letdown reflex and doesn’t produce enough?

    • Marie Biancuzzo

      Beneath your words, I hear some self-blame, confusion about what happened with your daughter and some mixed feelings on how (or if) to try breastfeeding your new baby. Easy for me to say — harder for you to do — but try to stay in the present. You can’t undo or re-live the past, and there’s no crystal ball for the future.

      As I hear your story, it sounds to me like you were born with what professionals would call asymmetrical breasts. Your right breast was substantially larger (and probably with adequate functional tissue, i.e., lobes and ducts) whereas the left breast was smaller (and probably lacking enough functional tissue.) Hence, you got the implant on the left to improve the “look.” But I’m suspicious that you were born with a less-than-complete functional tissue.

      Let me break this down a little more. Breast problems are either inborn, or acquired (through surgery, injury, or whatever.) In your case, I question if you have a problem you were born with (not enough functional tissue) and you definitely have acquired alterations in breast tissue from reduction surgery and augmentation.

      So Baby #1 was breastfed for one year, using both breasts. (With no formula?) To me, this sounds reassuring. Baby #2 breastfed for 6 months, and given your story about getting much/any milk from the right side, it’s temping to think that she was getting milk only from the left side. But I’d need a lot more data to confirm that there was “nothing” on that side. Hand expression technique isn’t difficult, but it’s not intuitive, either! I’ve seen plenty of mothers who tell me they got “nothing” but as soon as I give them a little instruction, they get milk. Hospital-grade pump? Hard to say with only one data point from years ago.

      Note that in the post on reduction surgery, I talked about how recannualization can and often does occur.

      As for preferences? Oh, that’s a whole other conversation! Many babies seem to have a “favorite” side. I’ve helped hundreds, if not thousands, of mother-baby dyads with this “favorite” thing, and I suspect it has little (if anything) to do with milk production. So I’d encourage you not to assume cause-and-effect based on the “favorite” side.

      I don’t think you (or I or anyone) has all of the data to explain what happened in the past. Much less what will happen in the future!

      Here’s one of my favorite words: Multifactorial! You have a multifactorial situation. There’s a lot going on in your history. I would encourage you to read Diana West’s book Defining Your Own Success. I would also encourage you to bring this post with you and visit a very knowledgeable IBCLC (not just someone who calls themself a “lactation consultant” but someone who has earned the IBCLC certification). Seek an IBCLC who has had substantial experience helping mothers who have had surgical intervention.

      I have no crystal ball. But if you were able to fully breastfeed your first baby for about 6 months and continue breastfeeding for a year, I am optimistic. It’s not a guarantee. I’m not hearing any “breast” event that happened between Baby #1 and Baby #2 that would explain her preference for apparent low milk supply. (There very well could have been some “baby” event that you were unaware of. I’ve seen this before.)

      With all of that said, I’d encourage you to try. You had a good experience with your son, a prolonged (and I assume enjoyable) experience with what sounds like plenty of milk. Take heart! You might have a repeat experience with this new baby!

  18. Cammi Jade

    I had a breast reduction a little less than 3 years ago. I am now 4 weeks post partum and struggling with nursing my newborn daughter. She latches decently, but I only produce about 1 to 2 oz of milk every 3 hours. 2 oz is even generous, often it’s barley 1.5 oz I can get. I’ve been breastfeeding first, then I offer a bottle and she’ll drink 3 oz, then I pump. Its never ending and I feel like nursing is doing no good because she’s still starving afterwards and needs supplementing. I love and desire the bonding from nursing and want her to have the health benefits of my breast milk but it is so sad to see I hardly make any, it seems I’m making less as time goes on. I also am on a medicine for intercranium hypertension which I found out can cause low milk supply so I don’t know if it’s the medication or the surgery or both. I am wondering if I should just give up or if even though I only get about 6 to 8 oz a day if that’s enough to keep doing it for my daughter despite it emotionally draining me and feeling discouraged every time I see how little I can produce. I don’t what to give up though and keep hoping it’ll improve but it’s already been a month and it hasn’t gotten better…

    • Marie Biancuzzo

      Cammi, I applaud your determination, and your ability to recognize that exclusive breastfeeding is not always the goal in every situation. I have a number of thoughts here. The first rule is always “feed the baby,” and you’ve done that. Absolutely.

      I don’t know how much milk you are actually producing. It sounds like you are pumping your milk after your daughter “latches decently.” However, as my beloved friend Debi Bocar said decades ago, “Mouth on breast does not equal breastfeeding. Audible swallowing equals breastfeeding.” So by 4 weeks, it should be fairly easy to hear her swallowing. Hearing her swallow tells you that she is transferring some milk to herself. It doesn’t mean she’s getting “enough,” but it does mean that whatever she has swallowed is being measured in the bottle when you pump afterwards. (Make sense?)

      On the intracranial hypertension, I’ve got several thoughts. You didn’t specify what your medication was, but I’d say two things. First, sometimes misinformation crops up about what a medication does or doesn’t do, so be sure the person who has prescribed it is quoting a credible source, for example, LactMed which is from the National Library of Medicine. (This is always my go-to source.) Secondly, there’s often more than one drug that accomplishes the therapeutic effect, so perhaps a different drug could be used without the worry about low milk supply. That’s a conversation you’ll need to have with the professional who prescribed the drug. Don’t be afraid to start that conversation.

      On what babies will take from a bottle. You say she “drinks 3 ounces” from the bottle you’ve offered. Does that means she’s taking 3 ounces of formula? She may indeed need those 3 ounces of formula that she is guzzling down; I don’t know. But it’s not unusual for babies to take formula from a bottle that is put in their mouths. At that age, sucking is a reflex. So seeing her take formula in a bottle is not a reliable indicator that she’s not getting enough milk from suckling. Maybe, maybe not.

      In short, there’s not enough information here for anyone to come to determine a cause-and-effect relationship. What you’re seeing may be attributable to low milk supply, poor milk transfer, the medication, or the surgery, or some other factor that is not immediately apparent.

      However, I do see two important factors that are clear in this story. First, your deep desire to experience the mutual bonding and the superior nutrition is apparent, and because of that, I would encourage you to continue breastfeeding. Second, the World Health Organization and multiple other authorities agree that some breastfeeding is better than no breastfeeding. And all of that supports the principle of “feed the baby”!

      My sense is that you need more information, and a complete evaluation by a professional or multiple professionals who can dig deeper into what’s really going on, and perhaps suggesting some alternatives that might be more aligned with your goals.

  19. susan

    Women who undergo intraductal papilloma removal surgery faced problem on breastfeeding as the some ducts are affected during the surgery, is there anyone could share related experience? Or any suggestions could reduce such impact?

    • Marie Biancuzzo

      I, too, would invite anyone who has had that experience to give us any insights. Meanwhile, I would caution that after having had surgery to remove an intraductal papilloma, there may be scar tissue. Scar tissue on the surface of the skin is easily visible. But there may also be scar tissue beneath the surface of the skin. If so, it may be lumpy (and maybe even tender to touch) and if so, it’s very possible that the baby would have trouble latching on.

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