Women’s Health Today

Tess shares her challenging and rewarding story of breastfeeding after reduction surgery and three key messages that really helped.

Living my teens and early twenties with breasts that were disproportionately large for my body significantly inhibited my ability to exercise and find appropriate clothing, caused back pain, and impacted hugely on my self-confidence. At age 24, the decision to have breast reduction surgery was right for me and dramatically improved my quality of life. My surgeon assured me that the surgery wouldn’t reduce my likelihood of being able to breastfeed. He said that only 66% of women with breasts bigger than a ‘DD’ cup could breastfeed anyway and quoted a similar percentage for women who could breastfeed post-reduction surgery. With hindsight, experience, and personal research I now question the accuracy of those statistics!

Seven years later, when I fell pregnant, I was surprised by the intensity of my desire and my husband’s commitment toward the idea of breastfeeding. Throughout the pregnancy, we mentioned my breast reduction surgery and intention to breastfeed to every health professional we met, asking what we could do to maximize my chances of producing milk. The responses were consistent:

• Strive for minimal intervention during the birth in order to establish feeding as soon as possible.
• Think positively about my ability to breastfeed.
• As breast milk is produced on a supply and demand basis, avoid giving formula as supplementation, which would be sure to decrease my milk supply.

Nell’s arrival was calm and uncomplicated. She was beautiful beyond words. Immediately after the birth, she was placed on my chest and crawled towards my breast as I began to leak colostrum. I was ecstatic. Although she was constantly at my breast over the next few days, she became increasingly unsettled. By the morning of our hospital discharge she had lost nearly 15% of her birth weight and the midwives reluctantly insisted we supplement with a small amount of formula. I felt I had failed my daughter.

Two days later, Nell had gained weight well and we were advised to stop supplementing with formula. This was music to our ears—I could exclusively breastfeed! But, over the next few days, her weight plummeted. So began an emotional rollercoaster and the upset was exacerbated by conflicting advice. Depending on which health professional we spoke to, we were either advised that, because of my reduction surgery, I should give up any hope of breastfeeding, or that my surgery was irrelevant and the only reason I had a low supply was because we had supplemented with formula.

We started and stopped supplementing many times over. Some days we supplemented with donor human milk from my sister and a close friend. However, on the days we needed formula, I heard the messages about its risks ringing in my ears. I felt I was giving my daughter poison, as well as ruining any chance of being able to breastfeed longer term. We were exhausted, devastated, and totally confused.

Help came just before Nell was two weeks old from a lactation consultant, who explained the crucial and often misunderstood differences between low milk supply as a result of reduced glandular tissue from surgery (which commonly requires some level of supplementation) and broader low milk supply issues (where supply can usually be increased solely through more frequent feeding and stimulation). We felt such a sense of relief to comprehend what was happening, as well as anger over the poor lactation advice we had received.

Our lactation consultant taught us how to supplement Nell through a tube in the corner of her mouth while she was at my breast (an at-breast supplementer), which enabled her to gain necessary weight while at the same time stimulating my milk supply. She outlined a range of strategies to increase my milk supply before it stabilized at the 12-week mark. When my husband and I confirmed our commitment to give it our best shot, she helped us draw up a breastfeeding plan.

I was prescribed domperidone [see Thomas Hale’s Medications and Mothers’ Milk for current safety rating] and started taking the maximum dose, as well as beginning a course of both osteopathic and acupuncture treatments. “Galactagogue” became a frequently used addition to our household vocabulary as my diet became centred on foods known to promote lactation and our cupboards filled with every herb, tonic, tea, and yeast we could find that might support our efforts.

Just after Nell’s birth we had hired a hospital-grade double pump and our breastfeeding plan involved waking Nell for a breastfeed and supplementary “top up” every four hours (which took about an hour), expressing for 15 minutes after each feed and doing a ten-minute “power-pump” between feeds. This feeding and pumping regime was exhausting, seldom allowing me more than 20 minutes’ sleep in any one block and requiring us to push back on almost all visitors. Slowly but surely there were gradual increases in my milk supply and by the time Nell was six weeks old, she had finally returned to her birth weight.

I cut back on one pumping session overnight (as I was in desperate need of a two-hour block of sleep) and one during the day, which allowed me to get out of the house daily for an hour. I finally summoned up the courage to attend a breastfeeding mothers’ meeting. Until this point, I had I felt like a fraud at the idea of going along, since I was not exclusively breastfeeding. In my sleep-deprived state, I became convinced they would kick me out if I pulled out a bottle of formula to feed my baby! However, I was desperate for the company of new mothers, so along I went.    

Other mothers spoke candidly about oversupply issues and how much easier feeding had become after six weeks. I couldn’t help being filled with envy. Feeding wasn’t becoming any easier for me. While I understood there were difficulties and pain associated with oversupply, it was so difficult to hear stories of excess milk that I would have given anything to be able to produce.

When it was my turn to share my experiences, as I opened my mouth to talk, my tears began to flow. I was touched by the sensitive, kind responses, particularly from the facilitator who assured me that all mothers were welcome, regardless of how they were feeding their baby. She scheduled a future meeting on “Mixed Feeding, Mixed Feelings” and sent me an article that captured well the shame I had been feeling.

There were three key messages I took away that really helped and have stuck with me ever since:

• You don’t have “half a breastfeeding relationship” with your baby, even if you are partially breastfeeding.
• Think of the breast as being half full!
• The inclusion of mother’s milk within mixed feeding still provides benefits, even if they are not as pronounced.

Every drop of breast milk counts. I continued with my efforts to increase my milk supply and by the time Nell was 12 weeks old, I could produce 70–80% of her nutritional needs on any given day. However, my pumping regime and the effects of the high doses of domperidone were not sustainable for the longer term and, as Nell became more active, I was starting to resent the pumping time that took me away from her.

We revised our breastfeeding plan to reduce pumping to six times a day, slowly weaning off domperidone and supplemented Nell through a bottle rather than at the breast. I was sad that these changes saw my supply drop slightly, and I feared this signalled the end of our breastfeeding, though the increased freedom it afforded me gave me more time to enjoy with Nell.

Two months later, I am currently providing about 50% of her nutritional needs with breast milk. I hope we continue breastfeeding for some time yet, though I will consider our breastfeeding experience a success regardless. I have recently read about breastfeeding promoting the regeneration and growth of glandular tissue removed during surgery, resulting in an increased milk supply for subsequent children. I love the prospect* that my breastfeeding Nell may also benefit any future children we may have.

I have learned so much about the mechanics of breastfeeding after reduction surgery and about strength and endurance.

My experience has instilled in me the understanding that a breastfeeding inclusive society involves recognition of a definition of breastfeeding that is broader than the exclusive provision of breast milk. I vividly recall my feelings of isolation from other breastfeeding mothers in those early days. This isolation has since dissipated as a result of contact with other mothers who are breastfeeding after breast reduction surgery, in addition to the opportunity to discover similarities with other breastfeeding relationships that, on the surface, appeared to be vastly different to my own.

The obvious enjoyment and comfort Nell receives from breastfeeding is one of my proudest achievements.

*Tess is currently enjoying breastfeeding her second daughter who is now 17 months old.

References

Cassar-Uhl, D. (2014). Finding sufficiency: Breastfeeding with insufficient glandular tissue. Praeclarus Press

Sriraman, N.K., Evans, A.E., Lawrence, R., Noble, R., & the Academy of Breastfeeding Medicine’s Board of Directors. (2017). Academy of Breastfeeding Medicine’s 2017 Position Statement on Informal Breast Milk Sharing for the Term Healthy Infant. Breastfeeding Medicine, 13(1)1–3. doi 10.1089/bfm.2017.29064.nks

West, D., & Marasco, L. (2008). The breastfeeding mother’s guide to making more milk: Foreword by Martha Sears, RN (family & relationships). New York: McGraw Hill.