I had breast augmentation surgery, will I be able to nurse?

Your surgeon needs to tell you whether he cut any milk ducts or major nerves. I assume he did since he said the top half would be okay and perhaps not the bottom half.

The "Breastfeeding Answer Book," published by La Leche League International, mentions two studies which found that most women with your type of surgery were not able to produce a complete milk supply. Half the women with surgery under the breast or near the armpit were able to produce enough milk. Any surgery to the breast also produces scar tissue which can cause problems as well. Later on page 436 the book goes on: "Although a full supply of milk will be produced in the milk producing cells, some of the milk will not be able to pass through the damaged ducts to reach the nipple. The more ducts that have been damaged, the less milk the baby will receive. (This is where some detailed drawings from the doctor would help to find out just how many nerves and ducts were cut.) However, there are reported cases of mothers' milk ducts growing back, after having been cut and they were able to fully breastfeed." (The last statement was not backed up by a study however.)

My best suggestion to you is to find a well-educated board certified Lactation Consultant (IBCLC) to follow you for a few weeks after the baby is born. She should examine your breasts before you have the baby and visit you as soon as you deliver or go home. She can evaluate the baby's feedings, sucking pattern and help you determine if enough milk is getting to the baby. If your nipples or breasts are at all numb or have less feeling in them, then the nerves have been cut.

It is possible to supplement the baby at the breast using a nursing supplementer, one is made by Medela (http://www.medela.com). Formula can be given while the baby nurses and gets your milk too. (The LC will help you with this item, if you need to use it.) If an area of your breast does not empty, then the milk cells in that area will quickly atrophy and stop producing. You would want to be aware of any tender areas in the breast tissue and watch for any sign of mastitis, but that can be easily treated with antibiotics. I do not think the concerns of the pediatrician are warranted. More likely, the problem will be evaluating the baby's intake effectively and making sure that he gets enough to eat. Counting wet and dirty diapers is the main way to tell intake. Regular weight checks in the first four weeks are very important--every week. Having an IBCLC helping you will give you a lot more confidence and she will be able to advise you on how to deal with the doctors as well.

Some La Leche League Leaders have had experience helping moms with this problem. If you have a LLL in your area, they will be a great support to you as you find your way through the early weeks. Their website also has a lot of helpful information, try doing a search on "augmentation surgery" or "breast surgery". You can also find out if there are any groups in your area by going to http://www.lalecheleague.org.

I wish you the best of luck. Your milk most likely will come in so you might as well try nursing. You may find that you enjoy it and want to combine formula and breastfeeding even after returning to work. Many women do that nowadays. There is lots of info on that too! Good luck.

Sincerely,

Elaine Matheny, BS, IBCLC, LLL Leader

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