Alga Kifle - VMC Foundation

Breast Feeding After Breast Surgery
Alganesh Kifle BSN IBCLC
NICU Lactation Coordinator
Breast Surgery Likely to Cause
Breastfeeding Problems
• According to the Institute of Medicine
(National Center for Health Research).
“Any kind of breast surgery, including breast
implants surgery, makes it at least three times
more likely that a woman trying to breastfeed
will have an inadequate milk supply “.
• ( In a study by Nancy Hurst from Texas
Children’s Hospital). 64%of women with breast
implant had lactation insufficiency compared to
7% of women without.
Breast feeding After Breast Surgery
• Assist and support a mother who wishes to breastfeed
after breast surgery
• Identify the impact of breast surgery on breast milk
supply and to assess ineffective breast feeding due to
nipple trauma and loss of milk ejection
• To encourage the mother to express her feeling and to
anticipate her unspoken fears
• Provide ongoing assessments through follow up until
optimal milk supply is achieved
Breast Injury and Surgery
• Reduction Mammoplasty — likely to have difficulty producing enough
milk, especially with periareolar incisions
• Augmentation Mammoplasty — compatible with successful breastfeeding
• Lumpectomy — may affect breastfeeding if significant nerves
or ducts have been removed
• Previous Treatment for Breast Cancer — radiation after lumpectomy may
interfere with lactation. Mother can usually breastfeed on an unaffected
• Trauma and Burns — varies, but many people with severe trauma and
burns to the breast have been able to breastfeed with success
• Pierced Nipples — not associated with breastfeeding difficulties. Nipple
devices should be removed before feeding
Breast Implant
Saline and silicon filled implants.( FDA, 2006. 2013)
For possible successful breast feeding there should be
no interruption of nerve or blood supply to the glands,
milk ducts or nipple.( Labbok, Global Breastfeeding Institute)
Breast Augmentation Technique
1. Peri areolar technique 1. An incision made around the
1. Infra sub mammary
1. An axillary incision
nipple and areola. Although there
is no visible scar there is often
loss of nipple sensation
2. An incision under the breast for
implant placement. Disadvantage
is that the scar is visible and
easily irritated by a bra
3. An incision made underneath the
arm placing the implant below
the gland or muscle. It has
minimal effect unless pressure on
the nerve pathway and ducts
Breast Reduction Mammoplasty
Exclusive breastfeeding might not be possible
after reduction. ( Human lactation, Harris,
stevens, et Frieberg).
However, mothers have the best chance of
lactation with the least amount of breast tissue
and milk duct being removed.
Also, if the fourth intercostal nerve that
branches to the breast and areola is left intact
there can be a sign of milk ejection.
Techniques of Breast Reduction
Length of Time Between Surgery and
Subsequent Pregnancy
• Despite the type of surgery a woman may seem to
have a better milk supply when her surgery occurred
five or more years before her pregnancy(West, 2002)
• The two processes are:
• Recanalization – where in breast tissue actually
regrows , reconnecting previously severed ducts.
• Reinnervation – the process whereby the nerves that
were damaged by surgery are regenerated.
Regeneration of such nerves would be a key
component of increased lactation capacity
Establishment of Breastfeeding —Hormonal Control
• Prolactin signals alveolar
production of milk
• Oxytocin causes milk to be
ejected into the duct system
(“let down”)
• Feedback Inhibitor of
Lactation (FIL) – small
whey protein whose
presence decreases milk
• Effective, frequent emptying
of the breasts is essential to
milk production
Feedback Inhibitor of Lactation
Breast is full
Breast is emptier
Presence of FIL
slows milk
Less FIL present
speeds up milk
Lactation Management for BFAR and
• Early prenatal lactation information
• Referral to a Lactation consultant upon admission
Assisting mother during First Hour skin to skin and breastfeeding
Teaching the mother cue based feeding , feeding on demand and
the use of Supplemental Nursing System
If mother and baby are separated ,assist mother with hand
expression of colostrum and follow up on her milk supply.
May use a milk pump log. Provide on going support.
• Obtain an electric breast pump, referral to community services WIC
and follow up with “ Bridge Program” when applicable
• Advocate for the mothers breastfeeding rights!
• Provide realistic information to breast feeding
mothers during perinatal period
• Inform the mother to anticipate initiation period the
First Hour “Golden Hour” Skin /Skin/ breastfeeding
• Prevent Filling Inhibitor of Lactation due to delayed
Lactogenesis II
• Maintain Lactogenesis III continuation of milk
production, option of medically indicated supplement
• Every drop of human milk is a precious enduring
treasure for a child therefore continuous support is
• note
• .
Breast Feeding After Reduction (BFAR)
Anatomy and Physiology
Latch On and sucking
Oxytocin Release
Releases Milk
Infant Empties Breast
Production Increases
Milk Production Occurs
Interference with this cycle decreases the milk supply.
Breast Reduction
• Mothers should be encouraged to breastfeed
early and frequently to stimulate the breast to
provide as much breast milk as possible
• Babies might need to be supplemented
• Supplementation can often be done at the
breast with a tube feeding device so that the
mother and bay can enjoy each other and the
breastfeeding experience

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