Breast surgery and milk supply

Did breast surgery decrease my milk supply?

Breast surgery can have a number of negative effects on the breast, and these are determined by the type of surgery and how it is done. Surgery may increase the risk of latching problems and nipple pain and damage by making the nipple root thicker or firmer, changing the location of the nipples, or increasing the breast size. It may alter nipple sensation. Mothers who have reduced sensation in the nipple and areolar areas may not feel pain, allowing more damage to occur, and those with increased sensation may feel more pain while breastfeeding. Breast surgery can reduce a mother’s milk supply. If the surgery is done on one breast, the other may compensate by producing more milk. If a mother has had breast surgery, the baby's growth should be monitored closely, and the baby may need to be supplemented with extra milk. If milk supply is low because of surgery, the mother may have difficulty increasing her milk supply. 

A) Describing breastfeeding problems caused by breast surgery

Breast surgery can have a number of negative effects on the breast and on milk supply and these depend very much on the type of surgery and how it was done.

1) Possible effects of breast surgery

Breast surgery can:

  • Thicken the nipple root.
  • Cut milk ducts.
  • Remove milk tissue.
  • Cut lymph (the fluid between the cells) ducts, preventing the draining of lymph and increasing the risk of swelling.
  • Reposition the nipple and areola.
  • Cut nerves and thereby reducing sensation in the nipple and areola.

As a result mothers can have latching problems, nipple pain and damage, or a low milk supply. Their babies are at a higher risk of growing too slowly.

Breastfeeding specialists can be very helpful in this situation.

2) Getting more information about the surgery

Before having breast surgery, women should discuss the type of surgery and its likely effect on breastfeeding with their surgeons. Women can then make informed decisions.

Mothers or mothers-to-be may not have discussed the possible effects of previous breast surgery on their ability to breastfeed. If they want more information, they should consider contacting their surgeon or the hospital where the surgery was done. This can help mothers identify problems they may encounter.

B) Risk of latching problems

Breast surgery may cause the baby to have difficulty latching because of:

  • Nipple root firmness from swelling because:
    • The milk cannot drain well if the milk ducts are cut.
    • The fluid between the cells (lymph) cannot drain well if the lymph ducts are cut.
  • Nipple root thickening or scarring causing inverted nipples.
  • Poor positioning as:
    • The nipples may be higher on the breast.
    • The breast size may be larger.

Mothers should use the pinch test to examine the nipple root before giving birth and monitor it for any swelling after delivery.

C) Risk of nipple pain and damage

Breast surgery can increase the risk of nipple pain and damage because of the same changes that make latching more difficult.

D) Changes in breast sensation

Breast surgery can change the amount of sensation in the breasts. Some mothers develop more nipple and areolar sensation, which may increase pain during breastfeeding.

Other mothers have less sensation and don’t feel the pain that normally warns of a problem. This is dangerous, because the treatment for nipple damage or infection may be delayed.

The decreased sensation may impair the let-down reflex and result in poor milk removal and in a decreased milk supply over time.

E) Risk of engorgement

Mothers who have had breast surgery may struggle with patchy areas of increased filling and swelling (engorgementwhen their milk comes in. This happens because the surgery has disconnected some of the parts of the breast that produce the milk from the ducts that allow the milk to empty from the breast. In this case, some of the usual techniques for treating engorgement will not work.

One rat study (Karacalar 2005) in which milk ducts were cut, showed that only half of the ducts repaired themselves and these were narrower than the uncut ones.

F) Risk of a low milk supply

Breast surgery can permanently reduce a mother’s milk supply by removing milk tissue or cutting milk ducts. If the baby has latching problems and the mother does not establish her milk supply well, the milk supply may be even lower. 

Mothers need to ensure that their babies are getting enough milk and if not, supplement them with milk

Mothers should consider maximizing their milk supply through effective breastfeeding or expressing and keeping the baby skin-to-skin after delivery (Bhurosy 2020). They may consider expressing in addition to breastfeeding to maximize their milk production. However, a mother may not be able to increase her milk supply past a certain point.

The type of surgery will influence how much milk a mother can make. 

Table: Likelihood of exclusive breastfeeding after breast surgery

Chances of a full milk supply on the affected breast

Procedure

Low

Breast cancer surgery

Possible

Breast reduction surgery

Breast lift surgery

Open biopsy

Breast abscess surgery

Male breast contouring surgery

Inverted nipple surgery

Probable

Breast augmentation

Nipple piercing

Very likely

Needle biopsy

If the surgery is before the birth of the baby, any reduction in milk supply would be evident soon after birth.

If the surgery is on one breast, it is not uncommon for the other breast to make enough milk to compensate for the weaker side. Indeed, some mothers breastfeed on only one breast and twins, triplets, and even quadruplets can be exclusively breastfed.

Mothers are encouraged to continue breastfeeding, even if the baby needs milk supplements, as there are numerous benefits

References

Bhurosy T, Niu Z, Heckman CJ. Breastfeeding is Possible: A Systematic Review on the Feasibility and Challenges of Breastfeeding Among Breast Cancer Survivors of Reproductive Age. Ann Surg Oncol. 2020 Sep 11

Karacalar A, Orak I, Aydýn O, et al. Spontaneous recanalization of the divided lactiferous duct in the rat. Ann Plast Surg. 2005 Feb;54(2):196-200