Should You Have Breast Reduction Surgery if You May Have Other Children?
Many women have asked us whether we recommend breast reduction surgery if a woman is considering future children. Because the reasons that compel women to have breast reduction surgery are complex, comprised of both physical and psychological issues, it is up to each woman to weigh the benefits of the surgery against the liklihood that she will not have a full milk supply for any future children that she may have. Although we cannot advise women about this very personal decision, we can offer the following information about issues and perspectives that are important to consider.
Reasons for the Surgery
Breast reduction (reduction mammoplasty) surgery is a very extensive surgery and carries significant risks inherent to any surgery. It is generally not considered to be cosmetic or aesthetic in nature as it is generally performed for well-recognized negative physical effects of carrying disproportionately large breasts. In fact, most health insurance carriers cover this surgery for that reason. However, there are also many significant psychological reasons that women have breast reduction surgery. The damage to self-esteem and sexual harrassment in a society that equates large breasts with promiscuity can be tremendously emotionally painful. Chapter 1 of Defining Your Own Success: Breastfeeding After Breast Reduction Surgery provides a thorough discussion of the many valid reasons women have breast reduction surgery.
Researching Beforehand
Most women do not undertake this surgery lightly. They research the benefits and risks prior to the surgery. Such thorough research often leads them to consider the effect of this surgery on their future ability to lactate, often leading them to this website. This research allows them to make a fully informed decision about the appropriateness of the surgery in their individual circumstances. If they should decide to have the surgey, they then understand that they may have an impaired milk supply and are able to take steps before the baby is born to prepare to maximize it. Those women who are unable to learn about breastfeeding after reduction surgery prior to the surgery are more likely to regret having it, often bitterly.
How Will Breast Reduction Surgery Affect Your Future Milk Production?
Athough we do not have statistics available that tell us the percentage of mothers who are able to breastfeed successfully after reduction surgery, after working with hundreds of mothers to help them breastfeed after the surgery, we do know that only a very, very small fraction of these moms have been able to breastfeed without supplementation. Most do not have a full milk supply for the first baby after the surgery. Time and time again, women will tell us that even though they may have been careful to find a surgeon who is "breastfeeding friendly" and they felt reassured that the surgeon would do everything possible to preserve their lactation capabilities, when they give birth they find that they do not have a full milk supply. The sad truth is that all types of this surgery can impact lactation, no matter how careful the surgeon is. There are types of surgery that preserve the lactation capability better than others, but even those types still result in impaired lactation for at least the first baby after the surgery in most instances. We urge you not to be lured into thinking that you could beat the overwhelming odds. If you have the surgery before you have your babies, it is very likely that you will not have a full milk supply for at least the first baby.
If You Do Have the Surgery, Which Technique is Best for Breastfeeding?
There are many different breast reduction surgical techniques. Most surgeons specialize in one or two. In North American, the Inferior Pedicle technique is performed most frequently. In order of least likely to most likely to impair the milk supply, the most common techniques are:
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Inferior Pedicle (McKissock)
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For a thorough discussion of each of these techniques, including their probably effects upon lactation, please refer to Chapter 2 of Defining Your Own Success: Breastfeeding After Breast Reduction Surgery.
When discussing surgical techniques with your surgeon, please keep in mind that the technique he or she performs is his or her perogative and he or she is not likely to accept a request for a certain techniqe. However, it is your perogative as the patient to select a surgeon who is willing to use a technique least injurious to lactation tissue.
Will You be Able to Breastfeed After the Surgery?
Depending upon the type of surgery that was performed, most
women can produce some amount of milk. Every drop is greatly beneficial for your baby.
Even iIf you do not have a full milk supply, it is important to know that many mothers breastfeed very successfully without a full milk supply by supplementing in ways that are supportive of breastfeeding. There are also many ways to increase milk production using a variety of methods that can include (depending on the individual circumstance and preferences) pumping, breast compression, deeper latching psychological conditioning, and galactagogues (substances that increase milk production).
When supplementation is necessary, some mothers supplement with at-breast supplementation products like the Medela SNS or the Lact-Aid, which are containers that hang around the neck with tubes that supply formula or pumped milk as the baby nurses from the breast. Using the at-breast supplementer is the ideal way to prevent nipple confusion and flow preference while maximizing milk production, but it does pose some challenges. It is not a device that works well for every every mother and baby, particularly when baby is not able to latch well or remove milk effectively.
For these and various other reasons, some mothers choose to use bottles to supplement. Contrary to the warnings about bottle use in the BFAR book and elsewhere, we now know that using them does not necessarily impact breastfeeding negatively. Many mothers have used bottles to supplement and have continued to have successful breastfeeding experiences. We now understand that there are ways to use bottles that minimize their impact. Click here for more information.
Realistically, it's important to understand that not having a full milk supply and needing to supplement, while at the same time taking measures to increase milk production, can be a lot of additional work. However, it is certainly well worth the effort for the tremendous benefits of breastfeeding.
This website provides many resources to help mothers who wish to breastfeed after breast and nipple surgeries.
How Will Pregnancy and Breastfeeding Affect the Size of Your Breasts?
Any lactation tissue in your breasts will enlarge during pregnancy, which enlarges your breasts, possibly to about the size they were before your surgery. This can be worrisome to women who do not want to go back to their previous size. Keep in mind, though, that it is pregnancy and not lactation that increases breast size, so if you don't have the surgery, your breasts will still enlarge during pregnancy, becoming even larger than they are now. Fortunately, most women find that their breasts return to the pre-pregnancy size after weaning.
Waiting to Have the Surgery Until After You Have Breastfed All Your Children
Although you may know with certainty that you want to have breast reduction surgery, one option to consider is waiting to have the surgery until you have completed breastfeeding all the children you wish to have. In addition to being able to exclusively breastfeed your children, you will also achieve a much better surgical result because the reduction will be performed after all the hormonal changes are complete.
As mothers, we have to make hard choices and we often have to make some sacrifices to give the best for our children. This is one area that you can make a personal sacrifice that will have HUGE rewards. You can put off this surgery for a few years and give your children the incredible benefit of exclusive nursing without formula.
For more information about breastfeeding after reduction surgery, we recommend that you read Defining Your Own Success: Breastfeeding After Breast Reduction Surgery.
Click here for a list of surgeon referrals
Quotations from Mothers Who Have Breastfed After Breast Reduction Surgery
The following quotations are from BFAR mothers who have generously and eloquently addressed the question of whether a woman should have breast reduction surgery when she plans to have more children.
Esther | Jennifer B. | Jessica | Amy | Maria | Tracy | Jennifer K. | Vicki | Karen
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I have yet to BFAR (we're trying now--my surgery was almost two years ago), but I already have one son whom I BF. I had the surgery after doing a huge amount of research. I was a 36J with a pretty small body structure (after surgery, I'm still around a 36D and I had 6 and 1/2 pounds removed). The weight of my breasts was beginning to cause problems with the disks in my lower back. I was in extreme pain all the time, and the doctors were telling me that I should not get pregnant again because that would likely cause irreversible damage. I tried every alternative I could find, including pain medication, physical therapy, back supports, specialty bras (at $60 per bra), and chiropractic care three times a week. After my surgery, I have been literally pain-free.
All that said, I still wonder how I will feel when I start to BFAR my next child. After the joy of breastfeeding my first child, I am painfully aware of what I may have lost. However, when I consider how much more I have been able to participate in my son's life, and how much nicer a person I am now that I'm not in pain all the time, I think it was worth it for me.
I would never recommend the surgery to someone who is not dealing with extreme pain. If there are other reasons for the surgery, they can probably wait until they are done having children. After all, if you are concerned enough to research this, you will probably be deeply disappointed if you have problems with BFAR (and most have some problems or concerns, even if they ultimately don't need to supplement). As far as self-esteem issues, I have a husband who assures me he loves my new breasts and wouldn't change them for anything, yet I still wonder many times if he misses "the old me."
To sum it all up, a breast reduction is not something that will just fix all your problems. It will leave you scarred, and it will leave you wondering if you did the right thing. If you're dealing with pain, it might take it away, but it might not. If you're dealing with self-esteem issues, it might help, or it might not. Or perhaps it may help in the short term, but later cause you more concerns. If you do decide to have the surgery, this is a great group of women to help you through any issues you might face.
Ultimately you have to make the decision for yourself, but just make sure you have thoroughly weighed out all the consequences.
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Jennifer B.
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It's such a complicated question for me to answer. I had my breast reduction shortly before I turned 22. I had enormous breasts that didn't really fit into the one style of DDD bra that I could find that somewhat contained me. I had ridges in my shoulders, was very, very droopy, had significant stretch marks and was agonizingly self-conscious.
I don't think the possibility of not being able to breastfeed crossed my mind as a reason not to go ahead with the surgery. I was not breastfed and at the time of my surgery thought it was not something I'd even consider doing. I had not even gone on a date before I had surgery, so future children seemed extremely abstract.
I was ecstatic after my surgery. I gained a lot of confidence, was able to run for a bus, buy pretty lingerie and get shirts to fit. I didn't regret my surgery until I got pregnant.
I prayed that I'd be at least able to give my baby colostrum. The first time I put my baby to breast I was enamored with the whole process. I'm not eloquent enough to express how amazing it is to look down and see you child being nourished and comforted by your body.
I told every medical professional I encountered that I had had reduction surgery and they kept reassuring me that I would be able to breastfeed. I had read a good portion of the book before my son was born (2 1/2 weeks early) and was very sceptical. I had at least 6 bs of tissue removed from my breasts. Unfortunately, I was right and all the doctors were wrong. I had to admit my child to the emergency room for severe jaundice on his 5th day. It was, by far, the worst experience of my life. I felt that I had starved my child (despite wet and dirty diapers to the contrary) and it has taken me months to forgive myself to a livable degree.
I never thought I'd use a supplemental nursing system but I have since about his third week of life (turns 5 months tomorrow). Bfaring has been the hardest thing I've ever stuck with! No doubt about it. I have cried and been angry and frustrated and eventually, extremely grateful about my situation. Breatfeeding has become the best tool I have as a mother. When all else fails, it seems to give my son comfort.
I regret my surgery everyday. Through the strength of the women here and with the support of significant loved ones I manage to persevere. I don't think my life would be as good as it is if I hadn't had my surgery, but I have doubts about that as well. If I hadn't had the surgery, I may never have had the confidence to find my husband and have my child. It's all very bittersweet.
Prior to having a child, I had spoken to friends and friends of friends on the benefits of breast reduction surgery (and it haunts me--how my uninformed enthusiasm might have influenced them). If you can wait until after you have children I would suggest that you do. If you can't, please use the BFAR forums and book to help you, but know going in that it will be a challenge.
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Jessica
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This is a very tough question. I had my surgery when I was a sophomore in college. I was so uncomfortable with myself and after the surgery I felt so much better about myself, I had so much more confidence. It is hard for me to say that I regret my surgery because I wouldn't be who I am today without it. Looking back, having large breasts was so much easier than not being able to provide my daughter with 100% breastmilk.
To be fair, I can not be certain that I would have cared as much about breastfeeding or have the wonderful breastfeeding relationship that I have with my daughter today. I have learned so much from the BFAR women and I feel like I am such a better parent for having known them. It is possible to breastfeed after a breast reduction. For most of us, myself included, it takes a lot of effort. There are women who do not have to supplement at all, but it is definitely a gamble. I would suggest that before you have the surgery to try and get a bra that fits you correctly and see if that helps at all. I wish that I had been properly fitted prior to my surgery.
If it is possible for you to wait until after you have finished having children, I would. If not I would join the BFAR list before you have your baby. They are a wonderful resource and an amazing group of ladies. If you have any specific questions feel free to ask them. I think that it is great that you are trying to get information before you make your decision. I wish I had found about the BFAR book earlier, prior to my daughter's birth. It would have made that first month so much better.
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Amy
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I do regret having had my reduction surgery. There are many reasons, but for the most part I just don't believe that there has been enough benefit to make up for all the downsides.
For one thing, my shoulders were still wide/big... when I got the surgery I was 17 and had very low self esteem. My mother talked me into the surgery. My body measurements were like 40-25-30. So yeah, I felt top-heavy. I felt like I couldn't wear t-shirts or other outfits that other girls wore. It was 1987 and fashion was thin bodies and small perky breasts. However I was still a girl, and it turns out that maybe I was just developing up top first and the rest of my body would catch up. Because now, 15 years and 5 babies later, my measurements are 41-35-40 (not that I'm not trying to lose some weight, <G>) and I no longer feel top heavy. In fact, my DH bought me some push-up type bras (I wear a 36DD; I was a 36 "small C or large B" after surgery) just because the lift makes me feel younger. <G>
Now, I know my breasts would probably be even larger if I'd not had the surgery. But my best friend wears a size 36I and after seeing what I've been through says she'd never even consider reduction, at least not until she is for sure done having children.
A lot of other BFAR mothers say that after their surgery
they had a lot more confidence and self esteem. That wasn't true for me at all. If anything I had even less confidence and self-esteem. I was horrified at my Frankenstein looking scars. At the time I was (um, how do you put it) an active dater, and it horrified me to think that I would have to eventually one day show my breasts to a guy that I was dating. Shopping for a swimsuit was just as hard as before surgery and possibly harder, because I had to find suits that covered my scars. Some swimsuits and even shirts were cut so low that you could see the scars between my breasts... other suits were cut so scanty on the sides that the scars under my arms showed.
I was also terrified for months and even years that everyone I knew would "know" that I had had surgery. I was always worried about who noticed and what they thought of me for it. I didn't date at all for the first year after my surgery, I was so afraid of people noticing my surgery.
I still hate my scars, 15 years later. I don't know, maybe I scar worse than some people or maybe my surgeon was bad... but I still have some itching in my scars, and numb areas that bother me. I have like flaps of skin that look like dog ears sticking out where my drain-lines were under my armpits-- had them when I weighed 117 and have them still at 162 so I don't think my weight has anything to do with it. Some of the scars grew really WIDE and are as much as 2" wide under my breasts. Areolar tissue seems to have "travelled" down there or something. I have a milk duct that leaks at a scar line, apparently from damage during surgery because milk is only supposed to leak from your nipple!
I got my hospital reports a few years back. It turns out I only had about 340 grams taken from one breast and 320 grams from the other breast. It just doesn't seem like I had *that* much removed to be living with these consequences. I just wish, every time I'm pregnant, that I could go back and erase the damage I did when I had the surgery.
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Maria
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I'm going to be able to give you a little different perspective on this issue. I had my surgery in 1993 at the age of 17. I am currently 28 weeks pregnant with my first child and right now Idon't know how I feel about my surgery. To be totally honest, I immediately felt better about myself after the surgery and I loved my surgery for the first 8 or so years. I felt so less self conscious about my body. It was like I finally felt comfortable in my body.
Once I started thinking about children, I started wondering what breastfeeding might be like for me. I watched my sister have two wonderful breastfeeding relationships with her children and wanted that for myself and my children. As a pregnant person, I'm having lots of concerns about what breastfeeding might be like for me. I can't say that I regret my surgery yet, but I also haven't gone through the struggles yet that so many women on this list have. Talk to me in April, and I may have more regrets than any woman on this list. I just don't know.
I'm so hoping that I will be able to provide 100% of her nutritional needs, but I know the chances of this are so slim. I am scared that I might be starving my child in the first few days and not know it. I'm scared that I won't know how much milk my child is getting and I will give in to supplementing when I don't need to. I have lots of fears about the future. This being my first child, I am not putting too much pressure on myself. I have given myself permission to try as hard as I can to breastfeed this child, but I will not blame myself if I can't. If I am able to give my baby even small amounts of milk, I will have given her something.
I have had to give myself permission not to feel guilty about this. I was young, and made the best decision I could at the time. I wasn't pressured into the decision by anyone, it was my idea, so I can't blame anyone else, I have to take all the responsibility myself. So, I'm going to do the best I can and try not to blame myself.
Like I said earlier, this is all coming from a pregnant one, not someone who has tried to feed her baby yet. I think you're very smart to think of this now. I would say that if breastfeeding is very important to you, why not wait until after you've had your children? It's something to think about.
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Tracy
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I do not regret my surgery. But, from what I can tell, I'm in a very tiny minority. And I can honestly say that has everything to do with the fact that I have a full supply. That in itself is not common. And if I had had anything less than 100%, I would have regretted my surgery deeply. I know, because I feel terrible regrets at any decision I perceive as a bad one and have a very hard time forgiving myself for those things and moving on. I didn't have a full supply with my first, though still made most of the milk she needed. But I hadn't realized that that was due to my reduction and therefore had no reason to blame it or regret the decision.
By the time I learned about BFAR, I was on my way to having my second child and thrilled to discover I had a full supply after his birth. Had I had less, I would have begun to regret my surgery keenly. Had I known before my surgery what I know today about BFAR (not about what my future supply would be, of course) and its challenges and heartache, and known the incredible joy of breastfeeding, something so deep and incredible, I would NOT have gone through with the surgery and risked all that. That is just my opinion, of course! One thing is for certain though, if you decide to put the surgery off or simply not do it all, you can always change your mind later. But once you go through with it, you can never, ever go back. I was very, very lucky, but I wouldn't have tried my luck back then, had I known how hard BFAR is.
Every single mom has to come to her own place where BFAR and her baby are concerned. And that place may be different for the same mom with each child. The word "success" in regard to breastfeeding had such different meaning to me when breastfeeding my first child, before finding the BFAR listserv and learning so much from the collective wisdom of so many very wise and experienced women there. And the meaning of "success" in regards to my own BFAR experiences has continued to change since then, even as I am continuing to nurse my two-year-old.
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Jennifer K.
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I am also in the minority of BFAR mothers who do not regret my surgery. I am who I am, and some of that is being a better person because of the surgery. Everything that has been said already is also me, so I'll try and keep it short! I had my surgery when I was 16 in 1987. I had my son 15 months ago.
Here is some bits and pieces of my journal from that point: When he was two weeks he still was slowly losing weight (no other signs so it was hard to hear), so I started supplementing formula with an SNS. I used the SNS for three months, and now I just breastfeed or he gets a bottle. (Some BFAR mothers use the SNS for much longer; I just couldn't take it anymore! I also didn't have the Lact-Aid, so maybe that one wouldn't be such a pain.) When I'm home all day, he might get one bottle when daddy is home, or when I'm at work he might get three bottles. (less now that he is on solids.) I have been VERY lucky that he hasn't had any nipple confusion or preference. I attribute this for using the SNS for such a long time.
I give my son every drop I can of breastmilk! At my breastfeeding group, he was the biggest guy under the age of 1(at 4-6 months)!!! And my doc said "he sure is one healthy breastfed baby!!! That rocked my world!!! (As you'll see, other mommies without reductions have the same problems we do, ours our just intensified in our own heads, and then it connects with the guilt-that's what you have to overcome!)
My son still breastfeeds, as I type, and probably will forever!!!!! Ok, it just feels like forever!!! HaHa! I take domperidone and herbs, and that gets very tiring very fast. Like someone else said, it is A LOT of work to breastfeed for BFAR mothers, yet, we all seem to hang in there and work even harder!
Now, I don't regret the surgery, but that doesn't mean that I haven't had my difficulties breastfeeding. I grieved about my milk supply and I doubt myself all the time, less now that he is older and not so dependent. (By doubting, I mean that ANYTHING that was going on I would first wonder if it had to do with my milk supply.)
The thing that really fit me that is in the book is how BFAR mothers feel guilty around people when using a bottle. I wanted to shout to the public, "I don't have enough milk, but I give him all I can." As if other people really care?!?! It reversed shame, because a lot of non-BFAR mothers have trouble breastfeeding in public, when that is all I would love to do!!! And, I don't judge others about what they feed their kids (even though I wished they all would breastfeed!!!), so I have worked on not judging myself.
It is really great that you are researching this. You are the only one that can decide for you. If it's not really bad, wait. If you are miserable, then maybe your mental state should be considered. However, as for breastfeeding, if you go through with the surgery you should know that it may/will be hard, very hard, and a lot of work. Best of luck to you.
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Vicki
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Like so, so many BFAR women, the decision to have a reduction surgery is done when any future would-be children are eons from any sort of an existence and the concerns of being a young, unattached woman seem so pressing. I have heard the same story line over and over again.
My regret in the whole process was my total lack of research into the subject at all. I marched straight to the first plastic surgeon's office I could find and signed myself up for surgery after one consultation without any further thought. I didn't care what technique was used and thought that any possible consequence wouldn't affect me. I didn't get any second opinions. I pretty much tuned out when the surgeon explained his techniques and I asked very little how it would affect breastfeeding. His one-sentence ambigious answer was good enough for me. I wanted to do anything to be rid of these two annoyances I was living with. Why didn't I bother to find out more? I wish I had, because that might have affected my choices. Like the different surgeries offered, a second opinion at least...
Even when the first child came I did no research about BFAR. Nobody could tell me anything anyway, but I didn't even bother to try and learn about how one normally breastfeeds, let alone trying to do so after a reduction surgery. I got a crash course in the first two weeks after my daughter was born, and the choices I had made eight years earlier all suddenly became important. Ultimately with my daughter I had a good supply (50%) and she nursed for 20 months. I think if I had even one drop less I would have felt some regret. Now my second child is born, and my supply is even better, but largely because I am finally more educated about BFAR.
Do I regret the surgery? No. Without it I would not be the person I am today. My regret is going into it so blind-sided. To do it over again I would have spent some time in research about how exactly this decision would affect me.
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Karen
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The year was 1994. I was 23 years old, a newlywed, a 34DD/DDD, very active, in extreme physical pain, and slowly becoming unable to participate in the activities I had enjoyed for many years. I knew someone who was a year younger than me who had the surgery in the late 1980's. I spoke with her about her surgeon and made an appointment with him. I listened very carefully when he explained the benefits, possible complications, and the risks of the surgery. He did tell me that with a breast reduction surgery the possibilities of breastfeeding were 50/50. At the time I'm not sure I cared because I hadn't even thought about whether I would breastfeed or not. I had my bloodwork done, and was set for surgery.
Fast-forward to May 2001. After many years of infertility, DH and I are finally pregnant! I watched my breasts for any signs of the changes pregnancy are supposed to bring about. I was thrilled to be seeing some of those changes. As fall turned into winter, we attended childbirth and breastfeeding classes. At the breastfeeding class, we met the Lactation Consultant who works with my OB/Gyn group. After the class I approached her, explained that I had a BR surgery about 7 years prior, conveyed my extreme desire to breastfeed, and asked for her help. This was by far the best decision I could have made for two reasons.
1) She promptly introduced me to "Defining Your Own Success" which ultimately led me to this group.
2) It always helps to have a friendly, knowledgable person in your corner before you attempt to BFAR.
I read the book cover to cover as fast as I could, and I immediately went to the website and signed up for the e-mail group. (Another good choice.) I read e-mails, referred to the book, waited, and prayed.
Samuel was born in January 2002 after a C-section. Within an hour I had my first attempt at BFAR. I'm not going to lie to anyone...the first four weeks were awful! I had flat/inverted nipples which I don't believe were related to my surgery since I had them prior to the surgery, and Samuel wouldn't latch at all to the left side. I used the SNS for the first 4 weeks of his life and would pump from the left after each nursing session.
In 12 months I have learned a great deal about myself, breastfeeding, and BFAR. Here is what I can tell you.
- I don't regret my surgery. Like many women here, I don't believe I would have become the person I am today if I had not had the surgery.
- Many women (not just BFAR mothers) have trouble breastfeeding, for many br different reasons. Trouble breastfeeding is not unique to BFAR women.
- That being said, I have found BFAR women, including myself, to be some of the most "dedicated to breastfeeding" women anywhere.
- Giving your baby breastmilk, any amount, for any length of time is more breastmilk than many babies get. No matter what your supply, you CAN give your baby the best you have to offer.
- Without a crystal ball, it's impossible to tell what you supply will be, or what it would have been even before your surgery.
- The women in this group are some of the best people I have encountered for support, compassion, advice, shoulders to cry on, and to share in your triumphs.
- A good, knowledgable Lactation Consultant can make a huge difference in your outcome...milk production and mental well-being.
Do the best you can to maximize what you have. For me, I would not have been the woman, wife, and mother I am today if I had not had the surgery. Everyone needs to decide for herself if this surgery is right for her. You need to be sure you are having a breast reduction for the right reasons...and that you are doing it for you, no one else.
I do want to add a footnote. I think it's important to note that I have been able to supply Samuel with all that he needs. Even when I was using the SNS for the first 4 weeks, I was using milk that I had pumped from the side he wouldn't latch to. I have had my share of worries regarding whether or not he was getting enough milk, and although those worries are less than when he was born, there is still a small (and now very quiet) voice in the back of my mind that every once in a while wonders if he is getting enough milk. I guess the bottom line is this. Breast reduction surgery is a huge, personal decision. Educate yourself about the benefits, risks, and complications. Not only the immediate ones, but the long-term ones as well.
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