AFTER BREAST REDUCTION
Guidelines for Mothers : by Wendy Nicholson OAM, RN RM LACTATION CONSULTANT
Most women have breast reduction operations (reduction mammaplasty)
because of the physical problems caused by abnormally large breasts. The
relief experienced after the operation is universal, and most women are
very satisfied with the outcome - they can exercise, buy `normal' clothes,
and they no longer have backache and other problems.
Advice:The question of the possibility of future breastfeeding may
or may not have come up during pre-operative discussion with your surgeon.
The most common types of operations are designed to preserve at least part
of the lactation function of the breasts. So most surgeons will advise
that breastfeeding may be possible, but that there are no guarantees.
Possibility of Breastfeeding: From our experience, it can be said that
the vast majority of women who have had breast reduction operations can
breastfeed, although only a few will be able to exclusively breastfeed.
Combining breastfeeding with formula supplements is the most likely outcome.
The woman can fulfil her wish to give her baby the best start while at
the same time ensuring the baby gets adequate food for growth and development.
Even partial breastfeeding confers great benefits for the baby - the immunological
and anti-infective properties of breastmilk, as well as the perfectly balanced
nutrients. The closeness and contact between mother and baby benefits them
Advice: During pregnancy, it is a good idea for you to gain as much
knowledge about breastfeeding as possible. This will assist you when you
have your baby and start breastfeeding. Attending Parent Education classes,
reading books (see list at the end) will ensure you get a good basic knowledge.
Starting Breastfeeding:It is important to have a good start to breastfeeding, to give your breasts a chance to demonstrate their capabilities.
2. Correct positioning at the breast and correct `latch on': If the baby is on the breast properly, he will be able to suckle and obtain the colostrum - the first milk - efficiently, wiithout cauusing any nipple pain.
3. Unrestricted feedings: It is vitally important that you feed the baby when he indicates that he is hungry, and to feed him until he comes off the breast of his own accord. Both breasts should be offered at each feed, and in the first few days at least, he will usually take both. Frequent feeds are the excellent stimulus for your breasts, and will quickly enable an evaluation of the situation.
4. No forumla for at least the first 24-48 hours: To `test' your breasts capabilities, it is important not to give the baby any breast milk substitutes; this includes water and formula. It is also a good idea to not use a dummy, because this can stifle the baby's desire to suckle.
1. Is the colostrum/breast milk coming through the ducts, and out the nipple?
This can be assessed by expressing your breasts, and by observing the baby on the breast. If the sucking is slow and rhythmic, with deep jaw movements, and the swallow `click' is heard, then the baby is getting milk. The baby will also usually be contented after a feed when he is getting colostrum/breastmilk adequately.
Is the `let-down' reflex working?
Is the baby getting colostrum/breastmilk?
Is the baby getting enough breastmilk?
What can you do if you have insufficient breastmilk?
Feeding: Babies learn to cup feed quickly, and will open their mouths
in readiness for the cup. Any small cup with a smooth lip or edge will
be suitable e.g. a medicine measure. The baby is held in a semi-upright
position, with his hands gently restrained. Rest the cup on the baby's
lower lip, and dribble the milk just into the front of the baby's mouth.
The baby will soon learn to lap or suck the milk. He may push some of the
milk back out with his tongue, so the cup is kept resting on the lip to
ensure no milk is wasted. Allow pauses as the baby needs them - let him
`control' the feed. Avoid a `tidal wave' of milk into the baby's mouth,
as this may cause him to cough and splutter. After a few feeds, the baby
usually becomes quite speedy at cup feeding.
Use of a Supply Line: Another way to overcome or avoid sucking confusion is to give supplements by a Supply Line (or Supplementary Nursing System). This uses a fine tubing which is taped next to the nipple, and comes from a plastic container of milk hung around the neck. As the baby sucks on the breast, he also gets formula through the tubing. The main disadvantage of this method is that it is a bit fiddly to use (although mothers who have used it say they soon get used to it), and it requires careful cleaning.
Advantages For The Mother: Some people may suggest that if you need to start supplementary feeds, you might as well change over to the formula completely. However, apart from the benefits to the baby of receiving your breastmilk, and the close contact of breastfeeding, they are not considering the benefits to you of continuing partial breastfeeding.
There are many advantages for the mother: think about some of the following.
Many mothers find that the night feeds can often be breastfeeds only, which saves having to get up to prepare formula. Many mothers, especially when they are very tired, just take the baby into bed with them, put them on the breast, and go back to sleep. On the other hand, your partner can give you a `break' and give a bottle, letting you sleep.
When you go out for a short time, you may find that you don't need to take bottles - if the baby does happen to need a feed, thhe breastfeed will usually be adequate to keep him happy until you get home.
If a baby has a cold or some other minor ailment, he is so easily comforted by breastfeeding. And breastmilk is particularly suitable for the unwell baby!
The other advantage of continuing breastfeeding, which is often not mentioned, is financial savings. Formula and its preparation cost money, and most people appreciate at least a partial saving in this area!
Support and Advice: Decisions about your progress with breastfeeding are ultimately yours. Health professionals and others will advise you, give their opinions, but you are the `boss' - it is your baby. You will do what is best for your baby and yourself.
Advice can be obtained from the midwives in hospital and the lactation consultant. After discharge, you may have the Domiciliary midwife visit you for some days at your home. Then the Maternal and Child Health Nurse will be your main health support person.
Many women find they gain great support and practical encouragement from the mother-to-mother support of the Nursing Mothers' Association of Australia (NMAA). One does not have to be a member to ask them for advice. However membership has definite advantages - not the least a delightful Newsletter, with many interesting articles and information in it.
Nursing Mothers' Association of Australia. (03) 9885 0855.
* Lactation Resource Centre, NMAA (as above). An expert resource centre.
If you are a `book' person, there are many good books about breastfeeding that you may be interested in. These are a few suggestions:
Bestfeeding: Getting Breastfeeding Right for You By Mary Renfrew, Chloe Fisher & Suzanne Arms.
The following articles may be of interest:
Newsletter Sept. 1987: p 14-14
NMAA Newsletter Aug. 1982: p 22-25
NMAA Newsletter May 1987: p 24-25
Promoting Breastfeeding: Victorian Breastfeeding Guidelines Revised edition 1996
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First put on the web on 27 Jan 1998
Revised 12 JUNE 2006