Breastfeeding After Anchor Breast Reduction

Anchor breast reduction is a procedure that reduces the size of the areola and removes excess tissue from around the nipple in order to achieve a more balanced look. This procedure is sometimes done in conjunction with other cosmetic surgeries, such as liposuction or tummy tuck surgery.

The good news is that many women who have had anchor breast reduction surgery can still breastfeed their babies!

How do you know if an anchor breast reduction will affect your milk production? The answer varies depending on how much skin was removed during the procedure and what part of the nipple was altered. If all of your milk ducts were preserved during surgery, you should be able to produce plenty of milk for your baby.

However, if there was some damage to your milk ducts due to the procedure, it may take longer for them to heal and produce milk again. You may also experience some pain when breastfeeding after anchor breast reduction surgery if your milk ducts were damaged during your procedure or if there were any nerve endings that were cut during surgery.

This exposition also talk about tips for breastfeeding after breast reduction and increase milk supply after breast reduction.

Breastfeeding After Anchor Breast Reduction

Breast Reduction and Breastfeeding

Making breast size smaller in a surgical procedure is known as breast reduction. This article discusses how breast reduction surgery can affect milk supply, whether women who have had breast reduction surgery can still breastfeed and answers frequently asked questions. For information about breast augmentation see Breastfeeding With Implants.Find an IBCLCSearch for a breastfeeding expert near you

Breastfeeding after breast surgery

To make breast milk, a breast needs glandular or milk-making tissue and a neurohormonal reflex to release the milk (see box). Any kind of surgery on the breast has the potential to disturb milk production or milk release to some degree. How breastfeeding might be affected after breast reduction surgery will depend on:

1. The type of surgery involved—whether important nerves and milk ducts (tubes that carry milk to the nipple) have been cut, whether the nipple has been repositioned, and whether the blood supply to the breast is intact.
2. How much milk-making (glandular) breast tissue remains
3. The length of time since the surgery

How breastfeeding works. A baby sucking stimulates a nerve by the nipple to send a message to the brain to release specific hormones (oxytocin and prolactin). Oxytocin signals breast milk to be released (let-down) from the milk-making tissue in the breast so that the milk is carried to the nipple through little tubes (ducts). Prolactin signals milk production. Any damage to the nerves, ducts or glandular tissue can affect how breastfeeding works after breast reduction surgery.

Tips For Breastfeeding After Breast Reduction

Strategies to increase milk supply are important for women who have had breast reduction surgery. The first two weeks after birth are the most critical for lactation—the more you feed the infant, the more the breast is stimulated to increase milk-making capacity. If the baby does not latch, consider using a breast pump to maintain this stimulation. Lactation experts are typically experienced in helping women who have had breast reductions with breastfeeding, and can be a wealth of information and support during this time. All methods of increasing milk production should be used: breastfeeding the baby, pumping, breast compression, relaxation techniques, herbal medicines and prescription medications if needed. Emptying the breast is important in increasing milk supply.

Increase Milk Supply After Breast Reduction

Breast emptying is an important factor in increasing milk supply, but the baby at the breast is most effective. Other methods include breast compression, relaxation techniques, and using herbal and prescription medicines that increase milk production (galactagogues).

#1 TYPE OF SURGERY

During breast reduction surgery, part of the breast will be physically removed and this could affect milk supply in a number of ways:

• Cutting across important nerves can reduce nipple sensitivity and affect the neurohormonal reflex that triggers milk production and let-down.
• Cutting through milk ducts means that areas of the breast may become engorged and ultimately shut down milk production because there is no outlet for the milk.
• If the nipple is removed and then placed on a reconstructed breast, the resulting damage to the nerves, milk ducts, and breast tissue will affect breastfeeding significantly.
• Scarring inside the breast may affect lactation. The scar pattern on the surface of the breast does not reveal the type of surgery.

Surgical techniques

Several surgical techniques are possible for breast reduction and some will have a greater impact on breastfeeding than others. The best chance for breastfeeding success will be where the procedure leaves the nipple and areola attached to the breast tissue beneath them. Lactation consultant Diana West has outlined a selection of techniques in her book Defining Your Own Success Breastfeeding After Breast Reduction Surgery and these are summarised below:

• Fat removal (liposuction). Cuts are made in the breast to insert a suction tube to remove fat deposits from areas of the breast. This may damage glandular tissue depending where the tube is inserted, and may cause scarring but is thought to be the least damaging technique for breastfeeding.
• Anchor type or inverted-T (inferior pedicle technique) involves removing sections of the breast and repositioning the nipple. The nipple is left on a mound of tissue (pedicle) so that it still has its nerves, blood supply and ducts intact. More glandular tissue may be retained with this technique compared to others which helps to preserve some degree of breastfeeding later. The surgery leaves a scar running around the areola (the darker skin around the nipple), a vertical scar from nipple to the chest wall, and then a horizontal scar under the breast in the crease where the breast meets the chest wall (inframammary crease or fold) making an anchor shaped scar.
• Around the areola (periareolar) technique involves making an incision around the areola and pulling out breast tissue through the incision. Glandular tissue will be removed along with fatty tissue and important nerves may be damaged.
• Central mound technique preserves the nipple and areola. However there is likely to be considerable damage to the glandular tissue due to the specific methods involved in reshaping the breast.
• Periareolar with mesh support (or “double skin”) involves a similar technique to the periareolar technique above however a synthetic mesh is inserted in the breast to provide support and reduce post surgery sagging. The technique can remove large amounts of glandular tissue and important nerves may be damaged.
• Superior pedicle technique (or “Lejour”) preserves the nipple-areola complex but can impact on the nerves and ducts as it removes a significant amount of glandular tissue directly below the nipple.
• Free nipple graft involves complete removal of the nipple and grafting it back to a new location on the remodelled breast. All nerves and ducts will be severed causing significant damage to breastfeeding and affecting nipple sensation. Even though establishing a milk supply is unlikely, it is possible for some nerves and ducts to reconnect and some sensitivity to return¹.

#2 HOW MUCH GLANDULAR TISSUE REMAINS?

Glandular tissue in the breast is interspersed with fatty tissue and it is not possible to say by just looking at the size of a breast how much glandular tissue is present before or after surgery. Therefore we can’t assume a large breast has more glandular tissue than a small breast or that a large breast can afford to be halved by surgery and still be functional. How breast reduction can affect milk-making capacity depends on how much functional glandular tissue is left after surgery. The more glandular (milk-making) tissue that is removed by surgery, the more likely it is that breastfeeding (milk supply) will be affected.

#3 HOW MUCH TIME HAS PASSED?

As time passes after breast reduction surgery, damaged nerves may reconnect (reinnervation) and severed ducts may make new connections to the nipple (recanalisation). Nipples that had lost any sensitivity may become more sensitive again and the capacity of the breast to make milk may improve.

Healing of milk ducts (recanalization)

Some milk ducts that have been cut or damaged seem to reconnect or develop new pathways to carry the milk to the nipple. The hormones of pregnancy and to an extent, the menstruation cycle can also help with development of new glandular tissue. Breastfeeding also helps this process—with each new breastfeeding experience, there can be a little more recovery and a better milk supply. Recovery will be limited by how much breast tissue remains and how many milk ducts.

EXCERPT FROM

Preparing to Breastfeed after Breast and Nipple Surgeries, bfar.org, 2016

Researchers found an average of nine ducts that came all the way through the nipple, but as few as four were also observed. A woman with nine ducts can afford to lose a couple, but a woman with only four really can’t afford to lose any. Though she may still have enough milk-making ability, if the milk can’t get out then baby can’t get it and that area of the breast will stop producing.

Healing of nerves (reinnervation)

An important nerve for triggering the release of prolactin and oxytocin is the fourth intercostal nerve. If this is damaged it affects let-down and milk production. According to bfar.org, a website dedicated to breastfeeding after breast reduction, damaged nerves can repair and reconnect at a growth rate of 1mm per month irrespective of breastfeeding². A good sign that this is happening will be when any lost sensitivity to touch and temperature returns to the nipple.