Breast and bottle feeding after reduction - does anyone have any experience? (A bit long - sorry!)

[florilegia]

This may be a bit wordy, but I'd really appreciate any advice anyone might have!

I had a breast reduction (LeJour-type) 6 years ago when I was 25. I had (I think) about 2lb removed from each breast, and went down from a 32FF to a 32D. I wasn't planning to have children at the time (had only just met DH-to-be), and I didn't really consider the possible implications for future breastfeeding...

I'm currently 25 weeks pregnant with DS1, and I have been worrying and reading up around the issue of breast feeding after reduction, and paying really close attention to what's going on in the general breast area. I'm probably symptom-spotting like mad, but I was wondering if anyone could tell me if these are positive signs of potential BF ability?

Post-reduction, I had crept up to a 34E, but I recently got refitted at Bravissimo, and I'm now in a 36GG (eek!). I'd swear I'm getting more sensation back in my nipples, and this morning I had a tiny leakage of colostrum, and then managed to express a few drops from each side. I'm hoping these are all good signs (I'm absolutely over the moon about the colostrum). However, I don't really know how much of an indication of being able to BF they actually are. Has anyone been in the same situation? I'd love to hear any advice you might have.

On a related note, I know that, even if things go well, the likelihood is that I would have to combine BF and bottle-feeding in some way from an early stage, as it seems as though lots of mothers who BF after reduction don't have a full supply. Does anyone have any recommendations for a bottle which would work in this context (i.e. would minimise nipple confusion etc)? I can't get my head around the idea of the at-breast supplementer devices... Also, has anyone ever tried Domperidone to increase their milk supply? I don't know how the NHS look on it - is it the sort of thing your doctor would give you on prescription, or do they tend to frown on it?

Sorry - that's a bit of a long post... Thank you if you've stuck with me for this long!

Hi - I was pretty much in your boots when I had my children, although my reduction was done in 1992 and I think surgeons have become better since then at preserving the milk ducts when they do reductions to allow for future breastfeeding. The really annoying thing is that nobody can tell you if you'll be able to breastfeed or how good your supply will be - you'll just have to wait and see.

I was dying to breastfeed and did produce both colostrum and milk, but on both occasions I just found my milk supply was far too low to sustain my babies. I was sad about it for a while but decided that some breastmilk was much better than none and mix-fed until 5 weeks the first time and 8 weeks the second. I loved breastfeeding for the intimacy it gave me with my babies. However, formula was where they got their nutrition and I couldn't have done without it. There was no nipple confusion to begin with - I just think they gave up on my nipple in the end as it was so much more work for very little gain and breastfeeding eventually became frustrating for everyone.

I tried Domperidone the second time round and had great hopes for it; however I didn't find it made much difference and eventually stopped it because it gave me stomach cramps. I have a sympathetic GP who was happy to prescribe it.

If you do a search on here for Domperidone and breastfeeding after a reduction you'll find some interesting older threads that are well worth reading. Good luck - I hope you will enjoy your baby and not worry too much if breastfeeding becomes tricky - my lot are living testaments to the power of Hipp Organic!

Hi there - you're right: the "not knowing" is unbelievably frustrating at the moment! I'm sorry to hear about your low supply, but it's great that you managed to mix-feed. Having been told by my surgeon that I definitely wouldn't be able to BF, I was pretty much resigned to having to FF from the first, so it's really encouraging to hear stories of any success, however big or small.

Thank you so much for all your advice!

Hi Florilegia

You sound just like me a few months ago. I expressed before hand and managed to get some colostrum and was thrilled but I never ever felt confident in my milk and this eventually led to me stopping feeding at 10 weeks - DS was not really getting enough from me. We also had a tongue tie,inverted nipples, nipple shields and masititis to deal with.

I have a few tips which I think should help. 1 see a breast feeding councellor (on NHS or Private) now before you have your baby and understand all you can about feeding. read everything you can ( I can recommend an excellent one in South London or tell you where to find one - PM me)
2 Understand when you should express and when not to (if you can and need to) as this led to my mastitis
3 Make sure you eat and drink throughout the day and always have water/biscuits etc by your bed. (DS fed for an hour and a half each time and I was wiped out so when he slept from 7am - to 10am I did too and didn't get any food in the morning leading to reduced supply
4 Buy this book - Defining your own sucess Breast feeding after Breast reduction sugery by Diane West - its a brilliant book (recommended to me by my lactation consultant)and will help you understand your situation and give you the strength to fight your corner should you need to with HV MW etc
5 Breast feeding is a bit of an unknown thing and when you doubt your supply it makes it harder so if you can breast feed and your baby is happy and healthy (doing all the things you need them to (dirty nappys etc) then TRUST YOUR SUPPLY - I spent so long worrying about mine that I found it hard to carry on feeding so I expressed - but was unable to maintain this going forward
6 If you can't do it try not to worry so much as 2to3 said there are excellent alternatives out there and having a horrible feeding experience and wanting to do something you can't can ruin your first few weeks/months with your new born

BEST OF LUCK! I think I did really well to get as far as I did - but I wish I had trusted my supply more and got into a routine earlier on as I might have lasted longer.

you cna buy it on amazon

www.amazon.co.uk/Defining-Your-Own-Success-Breastfeeding/dp/0912500867/ref=sr_1_1?ie=UTF8&s=books&qid=1289736278&sr=8-1-spell

please PM me if you have any questions or just want some support - I found very few people understood my problems as they were just worried about a baby latching on or pain in nipples - you get all that plus your own issues after surgery so you need a bit more help

x

I got Domperidone from my gp (as lactation consultant wrote them a letter saying I needed it) you can buy it over teh counter if not - it worked for increasing supply but also gave me tummy ache and gas! I was also told the tommee tippee bottles were the best for combining feeding.

No personal experience but I was just reading about this website the other day, you might find it useful. Best of luck!

Hi florilegia, I can give you some positive feedback: I have had breast surgery and managed to BF my DS to 10 months (and still going strong).
I would second the recommendation of the 'Defining your own success' book. Ultimately, you can only do what your breasts are capable of and if that means having to mixed feed then so be it - some BM is better than none.

I remember the feelings of guilt I had when I found out I was pregnant and was convinced I wouldn't be able to BF, all because I'd had a cosmetic op when I was much younger...BUT, I still don't regret having the op done because it gave me so much confidence and in all honesty I probably wouldn't have even got together with my DH if I hadn't had it done.

All the best.

hello! i had a reduction in 2004, didn't breastfeed my first daughter in 2007 because I didn't think I'd be able to, (my surgeon told me the same as you) but did exclusively breastfeed my second daughter who was born in July. I have had to stop at 3 months because of being on high-dose medication for Graves' disease, which I'm really sad about, but if that hadn't been the case things were looking promising for exclusive bfing to 6 months and beyond.

Everyone is different and I agree, not knowing what it will be like for you is very difficult. Different surgical techniques have different outcomes (outlined in "Defining Your Success") but even that isn't the whole story. In your baby's first few days just keep a close eye on wet and dirty nappies, as you would if you hadn't had a reduction. You'll know from that, and from how long it takes him or her to regain their birth weight, how well the feeding is going and whether you'll need to supplement.

I bought a double-pump (Ameda Lactaline) in case I needed to pump between feeds to boost supply, as suggested elsewhere, but never used it in the end other than later for bottles when I went out.

I didn't bother with Domperidone as I didn't like the sound of the side effects - maybe worth seeing if you'll need it first? I did take a lot of fenugreek from the first week, probably the best known herbal galactogogue, as the only side-effect of that is that you smell faintly of curry, but in my case no-one else noticed that. I don't know whether it worked or not but things were going so well that I didn't want to risk stopping it in case it was the crucial thing!

Best of luck. My best advice would be to try not to give yourself a hard time whatever happens. I told myself before my second daughter was born "I'll just give it a try, and if it doesn't work out, never mind". If only it were that simple! But I'm so, so glad I got the chance to breastfeed for even the relatively short time I did and I hope it works out for you too.

been thinking about this some more -

My experience was that advice for all breastfeeding mums in early days goes double for breastfeeding-after-reduction mums. So:

• lots and lots and lots (and lots!) of skin-to-skin contact, immediately after birth and in the days afterwards

• put the baby to the breast lots (and lots!), as soon as you can after birth and afterwards. In my case we had an impromptu SCBU stay of three days to contend with, and I had to hand express colostrum, but that turned out not to be a problem thankfully.

• let the baby meet all their suckling needs at the breast - don't give a dummy until breastfeeding is well established. Don't try to feed to any sort of schedule at first either, and expect lots of cluster-feeding: most newborns do this and it doesn't mean there's no milk.

-If you can, hole up with your baby in bed for the first few days after birth, baby in nappy only, and just cuddle and feed, cuddle and feed. All this will maximise your supply as much as possible, as from what I understand, the early days set the "baseline" for milk production in the next weeks.

Re bottles - if you do need to supplement there is an alternative called an at-breast supplementer, have a look on google. I thought they looked a bit of a faff but lots of mums get on very well with them.

Thank you all for your replies! I'm stuck in bed with a bad stomach bug at the moment , but I didn't want anyone to think I was being rude and ignoring them! I'll be reading properly as soon as I'm up and more awake

Hi florilegia!

Good advice in this thread. Mine would be to really not worry about things and definitely DON'T feel guilty if things don't work out.

I had a reduction in 2000 and was keen to BF DD when I gave birth in 2008. I too squeezed out a bit of colostrum (although it took a bit of manhandling!) before birth, and one consultant suggested collecting it and freezing it in pregnancy so I had an additional supply when DD was born - you might want to look into that.

When DD was born however she had a massive latching problem, which I think was caused by effect of the reduction on my nipples, so watch out for that too. You might want to invest in some nipple shields and use them and bottles.

I didn't have much success at all and was completely formula feeding by three weeks but I was glad I did the research rather than automatically reaching for formula so I recommend reading the book and looking at the bfar.org site.

Good luck!

Just to add to the other poster's stories. I had a reduction in 2001. When I had my little girl in 2007, we mixed fed from day 1 and fully formula fed from 6weeks. To be honest she wasn't the most enthusiastic feeder (on boob or bottle) but I was just amazed I actually produced milk.

I now have a new baby 11weeks old and he took to breastfeeding really well (if way too frequently at night for my liking!) and only has 1 bottle in the evening, milk supply doesn't seem to be a prob as he gaining weight well.

Good luck and you may find your boobs really surprise you!

Wow! Thank you all for your helpful responses: I'm so pleased to hear that so many of you managed to have a successful breastfeeding experience, and it's really giving me hope for February.

BigBad, I hadn't realised, but it turns out my midwife is also the local lactation consultant (at least according to google!): she has been great and very supportive, but she told me in my first appointment that she hasn't ever dealt with someone in my situation before. She's been researching the issue too, though, so it's great to know I'll have some good support in that area. Thanks, too, for the bottle recommendation!

MissIng I know what you mean about the mixed feelings regarding the operation: for me it was very much to do with helping back pain, which I suppose makes me feel less as though it was cosmetic (can you see I'm trying to justify things to myself? ), but I also had such horrible issues about my breasts (I remember being reduced to tears in the Debenhams bra department when the saleslady scoffed at me, "there's nothing for the people like you here"!) that I can't honestly say I regret it that much. It's the fact that there are such a lot of unknowns involved that has really been worrying me (if I knew BF was a no-go from the first, I suppose I'd have been resigned to the bottle, whereas now it's all "what if?" and impatience!). I'll just have to keep my fingers crossed, I suppose....

Emma, I had heard about Fenugreek, and I'm up for trying anything: DH likes curry, so he shouldn't mind the smell! Thanks for all the advice: I had heard about the at-breast supplementer, but I did think it sounded like a bit of a palaver!

Thank you all again for your help: I'm really feeling very inspired to know that there are other people out there who have been in the same situation. I was pretty much resigned to having to FF before I became pregnant, but now it feels as if there are a lot of other possibilities open, and it's great to know that others have had success. I'm sorry I haven't replied to everyone individually, but I really appreciate all your kind words and advice. I'm going to be referring back to this thread a lot over the coming months!

F xx