Diana West, BA, IBCLC, Long Valley, New Jersey, USA
Mothering after breast reduction surgery
When I became pregnant for the first time, the one thing I knew for sure was that I wasn’t going to breastfeed. I’d had breast reduction surgery and my surgeon had said it wasn’t possible. At the time of my surgery when I was 25 years old, there was no husband in sight, let alone children, so it didn’t seem important. I figured I’d just use formula instead—how much different could it really be? During my first pregnancy, I skipped all the breastfeeding chapters in all the pregnancy books I read and scheduled foot surgery for the week after giving birth since I wouldn’t have to worry about medications going into my milk.
When I became pregnant for the first time, the one thing I knew for sure was that I wasn’t going to breastfeed.
Well, Nature had a different idea about all this. My son Alex was born after a long labor and three hours of pushing under full epidural, but as soon as I saw him, I felt an immediate and undeniable need to bring him to my breast. It didn’t matter that I “couldn’t breastfeed.” I just wanted him there no matter what. He latched well and something in me shifted at that moment: I suddenly knew I wanted to breastfeed. I could see I had colostrum (the early milk), so maybe the surgeon had been wrong. Maybe I could do it after all. I was certainly determined to try. I kept bringing him to my breast any time he seemed to want to do it. I’ll never forget my father-in-law saying, “You’re doing it, Mom!”
At the end of that first long day, the hospital nurse insisted on taking Alex away to the nursery so I could sleep. She seemed certain it was the best thing to do, so I reluctantly agreed to let her. As soon as he left my arms, they seemed to ache from his absence. I laid awake, unable to sleep, while my husband Brad slept deeply on the other bed in the room. After an hour of aching for my baby, I put on my slippers and shuffled down the hall to the nursery. As soon as I got there, the staff said, “Oh thank goodness! He’s been crying since he got here!” I picked him up and sat down in the rocking chair. I nursed him until he was happy again and then took him back to my room. When I got sleepy, I woke my husband up to hold him so I could get a little sleep. We switched over like that until we were discharged from the hospital the next day. He hardly ever cried again in those first few days.
Alex seemed to be breastfeeding well—I didn’t have any pain—but after a few days, he lost so much weight that we realized he wasn’t getting enough milk and we had to begin supplementation. His pediatrician gave me a card for a lactation consultant, so I made an appointment with her. She introduced me to a new way of supplementing using an at-breast supplementer, so he could get formula while he nursed. I adored the idea of it because it made me feel like a fully breastfeeding mother.
In day-to-day use of it, though, I discovered that it wasn’t always convenient, so there were lots of times we simply gave a bottle. And not knowing any differently, we used the “fancy” nipples marketed to be best for breastfeeding, which were “orthodontic-shaped” and certainly didn’t look anything like my nipples. By about three months, Alex started to adamantly refuse to nurse at all, preferring the orthodontic nipples and faster flow of the bottles. He screamed any time I brought him to my bare breast.
I didn’t know enough to work through what I later learned was a nursing strike, but by this time I was so dedicated to breastfeeding and giving him my milk that I started pumping several times a day. On most days, I was able to pump about 60% of his what he needed. But there were so many times that my breasts were full of milk and he was hungry and crying while I scrambled to get the bottle ready. I ached to feed my baby at my breast, yet knew he would just scream if I tried. It was heartbreaking.
What was even worse was discovering that Alex was severely allergic to standard formula. He developed bleeding eczema rashes all over his body and vomited any formula except the wildly expensive hypoallergenic formula with predigested protein. We struggled to afford it, but there wasn’t any other option until a mother I met online gave me several hundred ounces of frozen milk.1 We bought a deep freeze to keep it in and stretched it as far as possible, but we still had to supplement with formula until he was over two years old because he also developed allergies to a long list of foods.
I was so determined to give him as much of my milk as possible that I continued to pump until he was 14 months old, when I became pregnant with my second baby and pumping started to hurt too much. During the long hours of pumping, I began exploring “Usenet Newsgroups” (the early Internet places to find other people) about breastfeeding. I spent a lot of time reading posts and connecting with other breastfeeding mothers. Five of us who had had breast reduction surgery started an email list for women who were trying to breastfeed after reduction surgery. We called it “BFAR” (bee-far): BreastFeeding After Reduction. I eventually started the bfar.org website to share information we had learned. The email list grew and grew, and eventually became a forum on the bfar.org website, and a group on Facebook.
My sister-in-law had warned me away from La Leche League, saying they were too radical, but my new friends recommended them, so I decided to go to a meeting. I was nervous that the moms there would judge me badly for feeding my baby with a bottle, but they were incredibly supportive that I was still pumping, even though my baby wouldn’t nurse, and they were very understanding about my reality that I couldn’t make enough milk because I’d had breast reduction surgery. In fact, after the first meeting, a group of moms came over to me and told me they thought I was a “heroine” for working so hard to give my baby my milk, which made me immediately tear up.
I learned how to connect deeply with my children, even when I couldn’t nurse them. I felt like mothering my children was the most fulfilling way to spend my days, even if some days were tough. And I discovered a sisterhood of nursing mothers that accepted me wholeheartedly as a member of their tribe.
I felt so accepted by that group that I became very involved and even applied to become a Leader with enthusiastic support. Of course, my application was gently rejected because I hadn’t nursed a baby at the breast long enough to have first-hand experience. I completely understood that valid reason and was determined to reapply when I had nursed my next baby the required minimum of nine months.
When I became pregnant again, I was passionately determined to do everything possible to make breastfeeding more successful. I ordered every kind of herbal galactagogue known at that time, bought two at-breast supplementers, rented two kinds of hospital-grade breast pumps, and then I made a decision that probably made the biggest difference of all: to give birth with midwives at a free-standing birth center (not connected to a hospital, but near enough to get there quickly if there was a problem) in Bethesda, Maryland, so that I could have a fully unmedicated, non-intervention birth.
I went into labor about a week after my due date and labor progressed so quickly without any medications that I delivered my second son, whom we named Ben, about 20 minutes after we arrived at the birthing center. He latched immediately and never left my side. Most amazingly of all, he never lost an ounce of weight. My milk came in by the end of the second day and he gained and gained and gained and gained. I kept waiting for that moment when we would need to start supplementing but it never came. He gained so fast that he was in the 90th percentile for weight at his first doctor’s appointment and stayed there for much of his babyhood. What a surprise after all my preparation for a low supply!
That isn’t to say that he didn’t have times when he cried so hard and so long that I wondered if he needed formula. But then I would look at all his rolls of chubby fat and see the proof that he wasn’t starving. I never needed to give him any formula and he never needed a bottle. I did have very, very sore nipples for about 12 weeks, but eventually the sores healed and stopped hurting. No one could ever figure out why it hurt—the latch looked fine. I much later learned he had a posterior tongue-tie, but thankfully it never reduced how much milk he was able to get.
The experience of nursing without supplementation was pure heaven on earth. Gone were the bottles, those horrid orthodontic nipples, and those expensive cans of powdered formula. Ben’s skin was butter-smooth and he didn’t have any allergies when he started solids. But best of all was being able to soothe my baby at my breast, mothering through breastfeeding as every instinct had urged me to do from the very first day in the hospital with Alex. I learned a whole new way of parenting through breastfeeding and La Leche League, which was a drastic improvement from the strict, punitive way that I had been parented. I learned how to connect deeply with my children, even when I couldn’t nurse them. I felt like mothering my children was the most fulfilling way to spend my days, even if some days were tough. And I discovered a sisterhood of nursing mothers that accepted me wholeheartedly as a member of their tribe.
During Ben’s first year, I reapplied to be a La Leche League Leader and was accepted. I completed my training and was accredited very quickly. I became a very active Leader in my local group and was also very active with the BFAR email list and website. Ben nursed until he was about three years old, just after I became pregnant for the third time.
It took me about two years to write Defining Your Own Success: Breastfeeding After Breast Reduction Surgery and we were editing the final type-set pages around my due date with my third baby. I asked my new unborn baby to hold off being born until we could finish the edits and he happily agreed, not initiating labor until three weeks after my due date, just as the book was finished.
Quinn was born in the same free-standing birthing center. Unlike Ben, though, he didn’t latch easily after the first day and I had to finger-feed him for several days until he figured it out. It took some persistence, absolute belief that this child was biologically designed to breastfeed, and lots of skin-to-skin time, but it finally happened and then he nursed wonderfully after that. It never hurt and Quinn gained just as well as his brother Ben, never needing formula or a bottle.
Since he was my last, I decided to let Quinn completely self-wean without any pressure (although I definitely put limits on some nighttime nursing sessions). But one day when he was about four and a half, I realized that it had been almost a week since he had last nursed. I asked him to nurse just one more time so I could have a last memory of it. He happily agreed, but never asked for it again. My nursing days were over. But I knew I would always think of myself as a breastfeeding mother. It had become a cherished part of my identity and the badge of my sisterhood.
A few years later, I added up the amount of time I’d been either nursing or pregnant and realized I’d lactated for 11 years straight. Not bad for a mom who never, ever planned to breastfeed!
1You can read more about this side adventure.
NOTE. Protocols for the careful and safe collection and handling of human milk are the responsibility of milk banks and networks, and LLLI encourages mothers to evaluate these protocols. It is not the responsibility of LLL Leaders or LLLI to license, recommend, or assess milk banks or networks. The US Food and Drug Administration (FDA) advises against informal milk sharing, especially when done over the Internet, because the FDA believes that the milk will not have been adequately screened for infectious disease or contamination.