Melissa Blanchard’s breasts were so large they gave her back pain and put pressure on her shoulders and neck that led to migraines. “I was really uncomfortable all the time,” she says. So when she was in her mid-twenties, she decided to have a breast reduction surgery.
After 10 hours of surgery, Blanchard had gone down several sizes to a C cup. The surgery was life-changing: Not only did she feel better physically but she also felt a lot more confident in her body. Her surgeon had told her there was a possibility the surgery would impact her ability to breastfeed, so when she was pregnant with her first daughter nearly 15 years later, she tried not to get too attached to the idea. “But once I had her, I really wanted to do it,” she says.
Blanchard was relieved when she was able to produce some milk while still in the hospital after delivery, but her daughter lost too much weight in the first few days, and the doctor told her she needed to supplement with formula. For the next few months, Blanchard would nurse, then give her baby a bottle of formula before pumping in an effort to stimulate her supply.
“Breastfeeding just felt like the right thing to do for her immune system, and I wanted the bonding. It was really hard when it wasn’t working,” says Blanchard. By six months, Blanchard gave up nursing altogether, opting to pump and feed whatever breastmilk she could garner by bottle, because her baby was getting so frustrated at the breast. At 10 months, she went to exclusively feeding her baby formula.
Problems with milk supply may occur in women who have had breast reduction surgery. During the procedure, a surgeon removes part of the breast that may include glandular tissue and ducts that produce and transport milk to the nipple. It’s not that breastfeeding is impossible, says John Semple, head of plastic surgery at Women's College Hospital in Toronto, "but the amount of milk produced from breasts after surgery may be reduced.”
During a breast reduction, some of the nerves responsible for sensation required for the letdown reflex, which signals your brain to produce milk when a baby sucks on your nipple, can also be severed.
Fortunately, with the most common type of breast reduction, the surgeon leaves the nipple attached and cuts around it. In these cases, nerves will typically regrow and you will regain sensation (although this can take up to a year after surgery). However, if you’ve had what’s called a “free nipple graft,” the nipple is actually removed and then reattached as a skin graft. In these cases, some sensation may return, but being able to breastfeed is unlikely.
Regardless of the type of breast reduction surgery, there is no way of knowing until after you’ve had a baby if you’ll be able to breastfeed. Taya Griffin, a lactation consultant in Toronto, encourages women who have had a reduction to try to breastfeed, but it’s a good idea to be prepared that you may have to supplement at least some of your baby’s nutrition with formula. "While it may be possible to breastfeed, more often I see mothers who have not been able to do so completely on their own," says Griffin.
It’s always important to get breastfeeding off to a good start, but Griffin says it’s paramount for women who have had reductions. “There’s almost no room for error,” she says. That’s because your breastmilk operates on supply and demand—the more your baby consumes, the more your body will make. If a bad latch or a tongue-tie are getting in the way, you won’t produce as much milk. Because of this, she recommends that every woman who’s had a reduction reach out to a lactation consultant—ideally even before birth.
Griffin says a lactation consultant or naturopath might recommend natural supplements, like fenugreek and blessed thistle, which are thought to boost milk production. She also encourages women to talk to their doctors about a prescription for domperidone, which can stimulate milk production.
If you do need to supplement with formula (or donated breast milk, if it’s available to you), Griffin suggests using a lactation aid, also known as a supplemental nursing system, where the supplemental milk is in a container attached to a tube which is placed into the baby’s mouth while he’s sucking at the breast. “This helps maximize the breast milk supply, but also means baby can exclusively feed at the breast, if that’s what mom desires.”
Griffin says many women she has worked with struggle emotionally if breastfeeding is difficult post-reduction, especially if they were younger when they had the surgery and didn’t understand the full extent of how it would affect breastfeeding—and how important breastfeeding might be to them in the future.
She says she approaches breastfeeding after a reduction surgery the same way she approaches all breastfeeding. “Go through all the steps of the things that you think are going to help you, like hiring a lactation consultant, or going to a clinic and getting support from Facebook groups, or La Leche league, and if you get to a point where you say, ‘look, I gave it everything,’ then don’t worry about changing the way you feed your baby if that feels right for you.”
For Blanchard’s second baby, now 14 months old, she breastfed for one month before moving to exclusively formula-feeding. With two children now to deal with, she couldn’t focus all her time and energy on something that just didn’t work well. She doesn’t regret the much-needed surgery, and she’s glad she gave both her daughters as much breastmilk as she could.
Now, she says: “With my first, I wish someone had told me, ‘you can try this if you want, but if it doesn’t work, it’s not because you’re a failure. It’s because the milk’s just not there.’”