Breastfeeding after breast reduction is possible!

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 if you plan to breastfeed after 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 post-surgical mother 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.

According to a plastic surgeon who specializes in breast surgery, 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’ve had a breast reduction, 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 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

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.

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

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