Breast reduction surgery, also called "reduction mammoplasty," is becoming increasingly popular. As a result, many women are concerned about how the surgery may affect their ability to breastfeed afterward. Although much research has been done on how breast reduction surgery affects breastfeeding ability, the interpretation of results is challenging.
There are several ways to perform breast reduction surgery, and each technique comes with risks. The timing of surgery is also important. This article explains how breast reduction can affect breastfeeding so you can be fully informed when planning for surgery.
Mechanics Behind Successful Lactation
Surgical Technique
Important factors to consider if you want to preserve your ability to breastfeed are the surgical technique, the amount of glandular tissue removed, and the preservation of nipple sensitivity. Choosing a highly skilled surgeon is essential. Your surgeon must make sure the blood and nerve supply is kept intact and as much glandular tissue is spared as possible. During your initial consultation with your plastic surgeon, it’s important to be clear that you plan to breastfeed in the future.
There are three types of breast reduction surgery: full preservation, partial preservation, and total preservation. Preservation means protecting the glandular milk-producing tissue just beneath the areola.
There are also five types of surgical incisions, which can impact the blood and nerve supply to your nipples. They are:
- Anchor or Inverted-T
- Vertical or “Lollipop”
- Donut
- Virtually scarless
- Minimally invasive
The choice of technique depends on your physical characteristics and attitude toward scars as well as your surgeon's experience and clinical judgment.
Amount of glandular tissue removed
Full preservation surgeries have the best breastfeeding outcomes. However, studies have shown conflicting outcomes when it comes to the amount of glandular tissue removed. Some studies suggest that the amount of tissue removed has no impact on the ability to breastfeed. Some showed that the amount of tissue does matter, but only when associated with decreased nipple sensitivity. Interestingly, when surgery was performed for extremely large breasts, breastfeeding actually improved because infants were able to nurse more easily from smaller, more manageable breasts.
Nipple sensitivity
Preservation of nipple sensitivity is very important when it comes to breastfeeding. Damage to the nerves that provide sensation to the nipple and areola during surgery is uncommon but also depends on the kind of incision used. Lollipop incisions, minimally invasive, or scarless tissues have the least chance of nerve damage and loss of nipple sensitivity.
Timing of surgery
The timing of surgery is important to consider, but there aren’t established recommendations because research studies have shown variable outcomes. You may want to consider that breastfeeding can permanently alter the shape of your nipples and breasts. Breast reduction after all your pregnancies may lend itself to improved results. One exception is if you are considering a reduction for very large breasts. In this case, having surgery before you get pregnant can be advantageous.
Breastfeeding recommendations and struggles
Breastfeeding has been shown to provide substantial benefits to infant and maternal health. The World Health Organization (WHO) recommends exclusive breastfeeding of newborns up to six months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. There is a huge push to get mothers to breastfeed, and, in the United States, 83% of moms attempt to nurse.
While most mothers are able to breastfeed, there are those who struggle. Some mothers are unable to produce enough milk or have other anatomic issues that make nursing difficult. Here are the most common physical reasons moms stop nursing:
- Insufficient milk production (19%-55%)
- Nipple pain (14%)
- Breast engorgement/ lactation delay (6%)
- Breast deformities such as extremely large breasts
- Breast surgery with partial or no preservation techniques (2%)
- Baby unable to latch (2%)
Here are the most common psychosocial reasons moms may not even attempt to breastfeed.
- Lack of encouragement (16%-30%)
- Discouragement by medical professionals
- Reluctance
- Nervousness
- Occupation-related concerns (8%)
- Poor prior breastfeeding experience (2%)
Take-away message
Over 90% of women who undergo breast reduction surgery are satisfied with their results. However, breast reduction may affect your ability to breastfeed. Although the vast majority of women who undergo breast reduction surgery are still able to breastfeed, you may want to consider waiting until your family plans are complete so you can maximize your breastfeeding success. You may also want to discuss your concerns with your plastic surgeon and develop a plan to optimize your breastfeeding success together.
Citations
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Aparecida de Andrade, Regina, et al. “Breastfeeding Pattern in the First Month of Life in Women Submitted to Breast Reduction and Augmentation.” Jornal De Pediatria, 2010,https://doi.org/10.2223/jped.2002.
Brown, Jennifer R., et al. “Breast-Feeding, Self-Exam, and Exercise Practices before and after Reduction Mammoplasty.” Annals of Plastic Surgery, vol. 61, no. 4, 2008, pp. 375–379., https://doi.org/10.1097/sap.0b013e318160223f.
Brzozowski, Dariusz, et al. “Breast-Feeding after Inferior Pedicle Reduction Mammaplasty.” Plastic & Reconstructive Surgery, vol. 105, no. 2, 2000, pp. 530–534., https://doi.org/10.1097/00006534-200002000-00008.
Chiummariello, S., et al. “Breastfeeding after Reduction Mammaplasty Using Different Techniques.” Aesthetic Plastic Surgery, vol. 32, no. 2, 2007, pp. 294–297.,https://doi.org/10.1007/s00266-007-9023-8.
Harris, Leonard, et al. “Is Breast Feeding Possible after Reduction Mammaplasty?” Plastic and Reconstructive Surgery, vol. 89, no. 5, 1992, pp. 836–839.,https://doi.org/10.1097/00006534-199205000-00009.
Jørgensen, Mads Gustaf, et al. “Superomedial Reduction Mammoplasty Affects Patients’ Ability to Breastfeed in a Distinct Manner: A Multicenter Study of 303 Patients.” Aesthetic Surgery Journal, vol. 41, no. 11, 2021,https://doi.org/10.1093/asj/sjab263.
Kraut, Roni Y., et al. “The Impact of Breast Reduction Surgery on Breastfeeding: Systematic Review of Observational Studies.” PLOS ONE, vol. 12, no. 10, 2017,https://doi.org/10.1371/journal.pone.0186591.
Sachs D, Szymanski KD. Breast Reduction. 2022 Aug 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 28723003.
Souto, Gláucia C., et al. “The Impact of Breast Reduction Surgery on Breastfeeding Performance.” Journal of Human Lactation, vol. 19, no. 1, 2003, pp. 43–49.,https://doi.org/10.1177/0890334402239733.
Thibaudeau, Stephanie, et al. “The Effects of Breast Reduction on Successful Breastfeeding: A Systematic Review.” Journal of Plastic, Reconstructive & Aesthetic Surgery, vol. 63, no. 10, 2010, pp. 1688–1693.,https://doi.org/10.1016/j.bjps.2009.07.027.