A past history of breast reduction surgery does not by any means that a mother cannot breastfeed. It does, however, mean that a mother is at a very high risk for low milk supply.
There is some theory that how much milk you make after a reduction can depend on a number of factors: how much breast tissue was removed, how long it has been since the reduction surgery, or how much breast growth has occurred during this pregnancy. But, in my experience, it is all a guess. I have seen BFAR mothers make literally nothing all the way up to an oversupply. (To be fair, the mother who made an oversupply after a reduction had made a triple supply for triplets before having a reduction).
When a breast reduction is performed, ductal tissue (milk making tissue) is severed and removed. The nipples are usually detached then reattached. Such significant change to the breast anatomy usually yields a marked decrease in the breast’s ability to properly make milk.
Mothers who have had a past history of breast reduction, in my opinion, should prepare themselves in pregnancy for the strong possibility that they will need to complement their nursing relationship with formula. Setting realistic goals and acknowledging that formula is a tool that will help them achieve their own definition of breastfeeding success will help prevent unnecessary shame and self-blame if supplements turn out to be necessary. They should also be armed with a plan to Super Stimulate their breasts to ensure the best milk supply possible.
Mothers who choose to breastfeed after a reduction also sometimes have a tricky time latching their babies. This is because post-operative nipples often lack the erectile function needed to make a firm nipple. These soft and mushy nipples make latching even trickier. Nipple shields can be helpful here.
When BFAR be armed with the following resources:
Engorgement when BFAR:
You may find that when your milk comes in, around day four, there may be sections of your breast that hard and full, but do not empty when the baby nurses or you pump. These ducts were most likely severed. I sometimes refer to them as “dead ducts.” The chance they will become infected is very low since they not connected to the nipple and bacteria cannot enter them. You should always be aware of the signs and symptoms of mastitis, though. These ducts will eventually get the message, reabsorb the milk, and stop producing, thus decreasing the breast’s overall ability to make enough milk.
For more about BFAR, read Amy’s story and check out the following resources:
The Breastfeeding Mother’s Guide to Making More Milk by Diana West IBCLC and Lisa Marasco MA, IBCLC
Defining Your Success: Breastfeeding after Breast Reduction Surgery by Diana West IBCLC