Breastfeeding After Breast Reduction and Tongue-Tie

New beginnings, Vol. 25 No.4, 2008, pp 27-28



 
It took me 10 years to make the decision to have breast reduction surgery because I did not want to go through it for cosmetic purposes. I worked on getting into shape and improving my body image and I had physical therapy, but nothing I did could take away shoulder, neck, and back pain. I was wearing 34 DD-E bras, but could hardly find any that fit right. It's no wonder. Now I realize that my cup size was probably an F. After the surgery I went down to a 36 C and the pain was gone the next day. I felt as though I had been given a new lease on life.
I was given the standard 50-50 chance of being able to breastfeed by my surgeon. At the time of the surgery I didn't much care, but when I became pregnant I learned as much as I could on the subject. I became determined to breastfeed my baby. Still, I tried mentally to prepare myself for the possibility of not being able to breastfeed. I did not take breastfeeding classes or go to LLL meetings, although I did a great deal of reading. In hindsight, more preparation would have helped me to deal with the situation.
We had so many obstacles in the beginning. I had hoped for a natural birth but ended up having a medicalized one, full of interventions. My daughter, Victoria, lost about 13 percent of her birth weight while in the hospital, and then gained weight very slowly. She was not latching on well or sucking well. I sought the help of several lactation consultants, who thought that the problems were partly due to the shape of my nipples and milk supply/flow problems as a result of the surgery. If my milk ducts had been cut during surgery, some of the milk would not have been able to pass through the damaged ducts to reach my nipple. So long as my ducts and major nerves remained undamaged, the milk supply should not have been affected. The ability to breastfeed following breast surgery depends on how well the milk can flow through. The more ducts that have been damaged the less milk the baby will receive. There are reported cases of mothers' milk ducts "recanalizing" (growing back) after having been cut, and the babies satisfying their nutritional needs through breastfeeding. It is possible that this may have happened in my case. The doctors also felt that because my baby was small and weak, she was not opening her mouth wide enough. I developed huge painful bleeding cracks on my nipples that took eight weeks to heal and I was left with scars.
I came very close to quitting, but I never did. Something happened the first time I put my daughter to the breast: I fell in love with nursing. I remember not being able to take my eyes off my baby while I was nursing her. I knew I could not take this away from her or from myself. I made a decision to stick with it, one day at a time. I received great support from my family, friends, and health care professionals. I also read the book Defining Your Own Success: Breastfeeding After Breast Reduction Surgery by Diana West, IBCLC, and received a great deal of information and support from the Web site dedicated to breastfeeding after reduction surgery: www.bfar.org.
When my daughter was about three months old I began attending LLL meetings, which became another wonderful source of support and motivation.
I followed a grueling regime of nursing, supplementing, and pumping around the clock for a couple of months. I had to deal with a low milk supply and the devastation of realizing that formula supplementation was necessary. I took herbal galactagogues (herbal substances to increase milk production or milk ejections). We struggled with syringe and finger feeding. I got a supplemental nursing system and mastered it in order to feed at the breast. The longer I breastfed, the more passionate I became about it. After about six weeks I felt we had turned the corner and things started to get easier. I continued to nurse successfully after I returned to work when my daughter was 12 weeks old. Victoria weaned a few months after her second birthday, when I was pregnant again.
I prepared for nursing my second baby as seriously as I did for his birth. I re-read Diana West's book. I ordered galactagogues and spoke with my health care provider about including a prescription medication in my routine. I bought a baby scale to monitor weight gain at home. I had the nursing supplementer and pump handy. I interviewed a couple of lactation consultants so that I would be comfortable with them and they would be familiar with my story and my needs when my baby was born. I was determined to have a better experience nursing my second baby. I was also hoping that my supply would be improved.
Andrew arrived after a fast and easy natural birth, but latching him on was not easy. The following morning I felt a familiar nipple pain and I thought Andrew was not latching on or sucking well. I called my lactation consultant right away. After helping me get him latched on, she did a thorough assessment and diagnosed tongue-tie. She explained to me that there are four types of tongue-tie. Types one and two are anterior or classic tongue-ties, where the frenulum is tethered near the front of the mouth. These types are diagnosed more frequently and many pediatricians agree that clipping them is beneficial. Types three and four are referred to as posterior tongue-ties, where the frenulum is tethered toward the back of the mouth. They are frequently overlooked and undiagnosed and many doctors believe they do not pose a problem. However, after learning more about the posterior tongue-tie, I realized that if left untreated, in addition to breastfeeding difficulties, it could lead to other feeding and speech problems in the long term, just like the classic tongue-tie.
I chose to have Andrew's frenulum clipped by an ear, nose, and throat specialist. While waiting for that appointment, my lactation consultant helped me to formulate a plan for maximizing Andrew's nursing efficiency and establishing my milk supply. I had been taking the galactagogues from the beginning. I also started pumping a few times a day and used the expressed milk to supplement him at the breast with a syringe or nursing supplementer. I was also paying a great deal of attention to his latch. This plan worked! Andrew's nursing began to improve and he started gaining weight very quickly. At one week he was nearly back to his birth weight. After the tongue-tie clipping, followed by a few sessions of cranio-sacral therapy, nursing improved even more. Right away I felt the difference in the quality of Andrew's sucking. Within a week my pain started to go away. I had one small crack on the right nipple but it healed quickly. I was elated to be making enough milk this time.
At four weeks I felt that our breastfeeding issues were successfully resolved. I had a strong supply. Andrew was gaining weight very well and he was nursing like a champ, and I was pain free. It was such a relief.
My lactation consultant says that "the baby drives the bus." By that she means that if the baby does not nurse well it can result in serious breastfeeding problems. So often the responsibility is placed squarely on the mother's shoulders: for example, she is not making enough milk or something is wrong with her breasts or nipples. Yet no one assesses the baby, who may be a big contributor to the breastfeeding problems. I wonder if my daughter had an undiagnosed tongue-tie since the problems that we experienced with my son early on were so similar to those with my daughter.
I marvel at how this time around most of our breastfeeding issues had nothing to do with the reduction surgery. Still, all the difficulties I went through with my daughter only reinforced my commitment to breastfeeding and fueled my passion for it. I am grateful for all the knowledge I gained and I am looking forward to nursing my son until he weans himself.