Mothers with Breast Surgery
Many women with breast reduction report they were not well informed about the risks of under-production, and therefore anticipate they will be able to exclusively breastfeed. They typically feel their milk “come in” and can easily express small volumes. Due to the disruption of the collecting system, it is the exceptional mother who can exclusively breastfeed. This may be a risk for any mother with peri-areolar incisions. Mothers should be encouraged and taught proactive measures to maximize production, and yet be provided realistic expectations, close follow-up and clear indications of inadequate milk intake.
Compensatory glandular development is poorly understood in humans. In animal studies, post partum mammary proliferation peaks early (within the first 2 weeks), and correlates with subsequent lactation performance (Fowler, 1990, Knight 1984). The brief window of time in the first few days may offer potential to maximize ultimate milk production.
While these mothers are more likely to be able to exclusively breastfeed than are mothers with breast reduction, they should be cautioned that implants may provoke engorgement and impair milk removal, and thereby compromise ultimate milk production.
Preventative measures should focus on frequent breast emptying. The implants themselves pose no risk to the safety or quality of the milk. Again, these infants warrant close follow-up and mothers need to know clear indicators of suboptimal milk intake.
- For mothers with breast reduction, explain that the ultimate potential for exclusive breastfeeding can be increased by practicing both breastfeeding 8-12 times per day as well as hand and pump expression for the first 3-5 days (See Appendix G). The frequency of milk expression during the first five days is more important than the duration of nursing or pumping in determining ultimate milk production capacity.
- For mothers with breast augmentation, teach hand expression and stress the importance of frequent, effective nursing and emptying, especially between the 3rd to 5th days.
Mother with breast reduction:
Some of the newer techniques for breast surgery enable some mothers to exclusively breastfeed, but this is not the rule. How we handle these first three days can make all the difference in how much milk your breast can ultimately produce. The best strategy is to increase the number of times we express small volumes of milk from the breast in the first 3 to 5 days, beginning on the first day. For example, every waking hour, hand express small volumes of milk from each breast (appendix G) for about 5 minutes. In addition to this, breastfeed frequently, 10-12 times per day, instead of the usual 8 times. You need to see your baby’s doctor if your baby is not having several liquidy, bright yellow bowel movements a day by the 4-5th day. In fact, it might be best to have your baby checked out when he’s about 3 days old. Have your doctor keep a close eye on your baby’s weight for the first two weeks.
Mother with breast augmentation:
When your milk comes in, in larger volumes, around the 3rd or 4th day, you may experience more pressure. During this time, the implants can make it a little more difficult for the milk to flow freely. We need to practice hand expression now, so that when you start feeling full, you’ll be an expert at getting the milk to flow. The plan is to keep milk moving through the breast every few hours – day and night. Any time you start to feel fullness, hand express a bit of milk, waken the baby to feed and then hand express again. This will make it much easier for your baby to nurse and more comfortable for you.
Babies At Risk
- C-section Mothers
- Mothers with multiples
- Infants who have not latched-on or nursed effectively for 12 hours
- Mothers of NICU or PSCN infants
- Infants supplemented more than once in 24 hours
- Infants < 38 weeks or less than 6 pounds
- Infant with loss of 10% birth weight
- Mothers with breast surgery
- Mothers with a history of breastfeeding failure
- Antepartum mothers at risk of preterm delivery