breast reduction and breast feeding/bottle feeding: ramble and questions

[lazyemma]

Hello

I'm currently 36 weeks pregnant. I had reconciled myself to the fact that I probably won't be able to breastfeed without some measure of difficulty as I had a breast reduction two years ago, after which my surgeon told me to assume I wouldn't be able to breastfeed in future.

I know that there are sites on the internet aimed at women like me - BFAR (Breast Feeding After Reduction) for one - and when I first got pregnant I did a lot of reading on the subject. I decided, after learning about lots of different experiences, which overwhelmingly seemed to involve weeks and months of expressing, watching one's baby struggle to gain weight, using "at breast" supplement tubes, ingesting all sorts of weird potions to increase milk production etc, and mostly a lot of stress and heartache, that trying to establish breastfeeding would likely be a big struggle and source of worry to beat myself up about when I have my baby, and that it would be the best thing all round if I just decided to formula feed from the start.

Yesterday, however, I was in the bath and kind of absent-mindedly tweaking one of my nipples, and a few drops of colostrum came out. I tried the other nipple, and same result. So it appears that my breasts, despite the trauma I've subjected the poor things to, are still in some kind of working order. Now I'm back to wondering whether I should at least give breastfeeding a try - which leaves me back where I started: how long do I persevere for? Would it be worth trying to breastfeed if only for a couple of weeks? How will I be able to tell when it's definitely not going to work out? Is the fact that I've produced some colostrum already a good sign, in terms of my chance of 'success'?

This has been a bit of a ramble and I suppose I'll have to find the answers to some of these questions myself, but I'd be interested to hear perspectives from people who've been in a similar situation. I know breastfeeding is an emotive subject and I've tried to be clear and objective about the various issues involved, but this is an important decision obviously and whilst I want to give my child the best start possible, I don't want the breastfeeding/bottlefeeding question to overshadow all the other aspects of parenting and nurturing that I'll be learning too.

lazyemma - I don't have any experience of this, but know that it is possible to bf even after surgery. You won't know until you try. Some surgeons try to min. damage to milk ducts, but it isn't always possible I guess.

I strongly advise you to get in touch with the leading bf counsellors too like La Leche League, NCT and others and ensure that they help you with the baby's latch, positioning and advice re, how to tell that the baby is feeding well, etc. They may also have some experience of feeding after surgery. Get in touch with them while you are still pregnant so you can get organised and not panick straight after the birth.

I hope someone with more experience of breast reduction comes along on this thread soon and helps

thanks yellowrose. Just to clarify, I know that breast feeding after reduction is possible, it's just that I'm trying to work out the questions in the latter part of my post - how long should I persevere for, how will I be able to tell if it's time to switch to formula, etc. The issue for me will be milk production, really - in that sense, I guess you're right and the only way to tell is to wait and see.

Hi Lazyemma
I breast fed DD for 6 weeks. She didn't lose any weight but at 6 weeks she was still at her birth weight so I introduced a bottle intending to mix feed. Unforunately after that she wasn't able to latch on properly and I had to switch to formula.
Don't under estimate how stressful it can be to breast feed after a reduction. I was constantly worried about milk production and ended up almost feeding DD constantly - no English speaking consultant near me so just tried to persevere.
Funnily enough though, because I had to switch to bottles, I used a pump to slowly reduce my supply and discovered that milk started to come out of more places on the nipple. Previously it had only come out of one/two places. I don't know if it was because of the pump or because that naturally happens when your milk "comes in".
Anyway, I would recommend that you take advantage of all the help on offer - whether it be medication to up your supply or home visits to make sure you're doing everything properly. I'm hopeful that next time (if there is one) everything will be different and I'll be more successful.
Good luck. I hope that everything goes well for you.

Hi Lazyemma,

It's very positive that your surgeon told you that you can breastfeed i.e. that he used a technique where as many milk ducts were preserved as possible.

However, you are absolutely right to take a pragmatic approach to this.

I had a BR in 1990 - this was in the "dark ages" when BF'ing was not really considered pre surgery. It was just assumed you would never be able to feed - at age 16, I didn't care. I lost 1.4kgs (700g's per side) and it was the best thing I ever did.

Fast forward 11 years to 2001. I just didn't think about it before my first baby was born, I was totally clueless. I tried to feed him, but I had absolutely NO informed support. The BF'ing counsellor in my area, whilst absolutely lovely, had no clue about feeding after a reduction, neither did the Midwife/HV/GP/Paediatrician. I was advised from every professional I came into contact with to formula feed. After a torturous week of trying to express and being too afraid to try and feed him (I was scared witless of starving him), I gave up. My bleeding nipples were a testimony to my effort (little did I know that even with "undamaged" breasts it is very difficult and often impossible to get a milk supply going by hand expressing alone). This awful cycle of trying/failing/trying/failing really, really knocked my confidence. It was hideous, stressful and compounded by the fact that my tiny baby turned out to have a formula intolerance which led to him screaming for hours in pain. I ended up with PND.

Anyway, it's not all doom and gloom .

A few years later I found out I was pg with DS2. Like you my breasts produced colostrum (as they did with DS1). This time I decided to be much more pragmatic about feeding. I decided that I did not have the confidence to feed him exclusively and that I was not going to beat myself up about that. I bought the BFAR book which I read from cover to cover - taking what I thought applied to me and educating myself in everyway I thought necessary. After 13 years I went back to my surgeon blah... blah.

DS2 was born and latched straight away. I fed him for the whole night after he was born. The next day he started to show signs of wanting a proper feed. I continued trying to feed him but my confidence waned. My breasts became engorged and once again I tried with a manual pump to pump some off. I soon realised that manual pumping was not working and that I was in danger of repeating the whole sorry saga. I dispatched DH to buy a box of formula and took the decision to mix feed my son - I would offer him the breast first and then a bottle. It worked well, but my milk supply never became established, after 7 weeks we stopped the mixed feeding. I was confident enough as a mum 2nd time around to know that I had done my best.

Forward another few years and I am pregnant again. I have been producing colostrum for ages now (am 30 weeks). This time I intend to express and freeze the colostrum. I will repeat exactly what I did with DS2, except I am going to supplement with frozen colostrum and if I run out I am going to cup feed formula. I have set myself a two week time limit to see if my breasts actually do work.

If you haven't fallen asleep by now, I think my (very longwinded) point is, is that although it's possible I just wanted to voice my support for you and tell you that you are taking the absolutely right approach.

Be careful of dodgy advice when your baby is born (there are loads of people out there who mean well but just do not understand what is involved with feeding after a reduction). Above all enjoy your baby - latch him/her on after the birth and enjoy that for as long as it lasts.

lazyemma - I agree with dejags that you have to look at all your options.

However, although the LLL and NCT, etc may not all be experts on breast reduction, they will still be able to help you with proper latch, good positioning, explaining demand/supply, how often you should be feeding, etc

I don't want to go on about these issues now, I think the bf experts are better positioned to do that.

May I also refer you to kellymom.com which explains what you should expect in the first weeks after birth. It is the leading bf site on the web and very scientific.

If you have any questions after the birth, come back here and others may be able to help too.

Good luck

Hiya

I had breast surgery and lost half the milk ducts on the left hand side. Funnily it's the BEST side in terms of milk production, so you never know. Just don't beat yourself up if it doesn't work out.

Good luck