Breast reduction surgery

How does breast reduction affect milk supply?

Mothers who have had breast reduction surgery are at a very high risk of not having enough milk for their babies. Their babies should be watched closely to ensure they get enough milk. Breastfeeding success after reduction surgery depends on the amount of breast tissue that was preserved behind the areola. Success rates are much higher when more tissue is preserved. Breast reduction surgery may also cause problems with latching, nipple pain and damage, and engorgement. Changes in breast sensation can lead to increased pain or delayed treatment for nipple injury or infection. Before breast reduction surgery, mothers should discuss the type of surgery and its likely effect on breastfeeding with their surgeons.

A) Risks to milk production from breast reduction surgery

Typical breast reduction surgery scars at the outer edge of the areola and vertically down from the areolar edge.

There are many types of breast reduction surgery. Our clinic helped in a review of 51 studies of the effect of breast reduction surgery on the ability to breastfeed (Kraut 2017). The studies used 31 different surgical techniques. Our study found that breastfeeding success varied widely, depending on the amount of breast tissue that was preserved behind the areola

Table: Breastfeeding Success After Breast Reduction Surgery (Kraut et al. 2017)

New studies continue to show the negative effects of breast reduction surgery on breastfeeding (Jørgensen 2021).

At our clinic in Western Canada, the vast majority of patients who have had breast reduction surgery had the type of surgery that does not spare the milk tissue but keeps the nipple and areola attached to the breast. The result is a permanently low milk supply. Of the hundreds of mothers with breast reduction surgery that we have cared for, only three had a full milk supply.

We have found that these mothers generally make between 60 millilitres (2 U.S. fluid ounces) and 300 ml (10 oz) in 24 hours instead of the expected 800 ml (27 oz) between one and six months after birth. The occasional mother made up to 600 ml (20 oz). 

Occasionally, the nipple and areola are completely severed from the breast and relocated. These mothers would be expected to produce very little milk. 

B) Other breastfeeding problems after breast reduction surgery

This baby boy’s mother had breast reduction surgery and was unaware it was likely to affect her milk supply. Until large amounts of infant formula supplements were started at nine weeks of age, the baby was breastfeeding very often, generally unhappy, and thin. After nine weeks, the baby had a normal feeding pattern, was happy, fleshy, and gained well.

Breast surgery can cause a number of other breastfeeding problems. The following are the most common ones following breast reduction surgery. 

C) Preventing breastfeeding problems

Mothers who are considering breast reduction surgery or who have had it, should take extra care to prevent breastfeeding problems. Indeed, mothers who have had a breast reduction are at a very high risk of not having enough milk for their babies. Their babies should be watched closely to ensure they can latch and can get enough milk. Newborn babies are likely to show signs of being underfed within a day of delivery.

References

Jørgensen MG, Albertsdottir E, Dalaei F, et al. Superomedial Reduction Mammoplasty Affects Patients' Ability to Breastfeed in a Distinct Manner: A Multicenter Study of 303 Patients. Aesthet Surg J. 2021 Jun 26:sjab263

Kraut RY, Brown E, Korownyk C, et al. The impact of breast reduction surgery on breastfeeding: Systematic review of observational studies. PLoS One. 2017 Oct 19;12(10):e0186591