Jen

I was the first girl in my 4th grade class to need a bra, and I wore a D cup by 8th grade.  I went through those difficult puberty years hating my breasts and the unwanted attention I received because of them, particularly from men much older than me.  I developed a hunched posture trying to hide them and wore baggy clothes.  When I reached my early twenties I started to travel extensively because of my work and studies and spent a lot of time living in tropical climates.  I suffered from yeast infections in the folds under my breasts, back pain, and deep and uncomfortable shoulder grooves.  My bras hurt me.  I could never find one that was comfortable.  Not only that, but I still had the lingering self-consciousness about my breasts that held me back socially and made a lot of physical activity uncomfortable and awkward.  So I had a breast reduction at age 23.  Afterward, I could jog, I could fit into a bathing suit, I could wear comfortable bras, I felt like men talked to me rather than my chest, and I absolutely loved it.
 
At the time of my reduction, I asked my plastic surgeon about breastfeeding and he told me that he used a new technique that should not interfere with my ability to breastfeed (inferior pedicle), and that most of his patients who wanted to breastfeed after surgery could do so.  He also told me that in some rare cases if he accidentally severed something he could tell the patient after surgery so that at least she would know.  After my surgery he told me that he thought he had done a very good job of keeping everything in tact and that I should have no problem breastfeeding.
 
Ten years later I became pregnant with my first child.  I always assumed I would breastfeed my baby, and in my third trimester I started reading everything I could find about breastfeeding.  I was surprised to see that many books seemed to suggest that women who had breast reductions may be unable to breastfeed.  I also learned that many plastic surgeons do not always make clear the distinction between being able to breastfeed and breastfeed exclusively, and that with the technique my surgeon used, it certainly was not guaranteed that I would be able to breastfeed exclusively.  I used the bfar.org website as a resource and informed my pediatrician and my obstetrician of my concerns.  Both were very supportive and essentially said that we should all proceed with the assumption that I would be able to do it unless we began to see evidence to the contrary.
 
When my sweet baby Isa was born, I did everything "right" in terms of establishing my milk supply: breastfeeding within an hour after birth, no pacifiers, no supplements, no bottles, nursing on demand, and lots of skin-to-skin contact.  I got help and support from lactation consultants, La Leche League leaders, other nursing moms, books, and my doctors.  Looking back now, I think many of the "problems" I had in the early months of breastfeeding are common and happen to women who have not had reduction surgery, but in my mind everything was due to the reduction.  My baby seemed to be always hungry.  In the first two months she basically nursed every other hour for an hour.  At night she wouldn't seem satisfied even after nursing for an hour.  Sometimes I couldn't make her wait a full hour passed before feeding her again.  Many times she would fuss at the breast as if she were frustrated that nothing was coming out.  She would appear to want to nurse and then pull at the nipple and hit my breasts with her tiny fist.  I often felt very upset.  I thought she wasn't getting enough, and that the surgery (and I) were to blame.
 
And yet... she was born in the 80th percentile for weight and height, and by her 2 week appointment, had gained back all of her weight that she lost in the first week.  By her 4 week appointment she was in the 90th percentile.  By her 6 week appointment she was in the 95th percentile, where she has stayed until the present (7 months old).  By 4 months my milk supply was well established and not plentiful, but definitely sufficient.  We didn't have any more of the fussy feedings, and I finally understood how rewarding breastfeeding can be.  I also think I relaxed as well. 
 
I returned to work full-time when she was about 3.5 months, and I sometimes had to supplement with a few ounces of formula here and there when I couldn't pump as much as she seemed to want to take in her bottles.  I never had to supplement at night or on weekends.  I think if I had stayed home with her and not returned to work, I might not have had to supplement at all.  I'm not a prolific pumper, and I often pumped in the middle of the night after a feeding (like if she only nursed from one side), or in the early morning before work in order to have enough.  Sometimes after a few weeks my supply will start to decline, and I will take fenugreek for a week to get it back up.  I have taken fenugreek on and off throughout the breastfeeding.  I estimate that I probably gave her about 85 to 95% of her intake prior to introducing solids.  Once we started giving her cereal at around 5 months, the supplementation with formula has no longer been necessary, because I've been able to pump enough for her.  Now at 7 months, we are still going strong.  I love breastfeeding my baby.  I love the closeness that we share while nursing.  I love the opportunity to snuggle with her, and the way she relaxes in my arms, and the fact that I am giving her the best possible start.
 
I am not sure, really, to what extent the surgery affected my ability to breastfeed.  I now believe that part of the difficulty in those early months was just the way she was as a nurser (liked to linger at the breast, liked the milk when it was flowing fast, got frustrated when the flow slowed, and was a bit colicky and often sought the breast as comfort, which appeared to me to be hunger) and part of it was probably rechannelization.  Generally, I know of women who have not had reduction surgery who can pump a lot more than I can, but other women who have not had reductions are unable to pump as much as their babies would like to take in their bottles (possibly because breastfed babies may take more in bottles than they would at the breast because it is faster flow and they do not realize they are full until after they have finished the bottle).  I also do not think my breasts store very much milk.  On a few occasions, I have had to go for a longer than normal period without pumping (like 6 hours) and the amount that I am able to pump is not dramatically different than what I would have pumped after 3.5-4 hours.  I also, on those occasions, did not feel dramatically engorged, just a bit fuller and heavier. 
 
I plan to continue to breastfeed Isa for as long as it works for us, and I feel excited about the prospect of having another child and being able to breastfeed without feeling such anxiety in the beginning.  It is hard to say whether I would do the surgery again after my experiences breastfeeding after a reduction.  Several years after my surgery I gained weight and my breasts became almost the same size as they were pre-surgery.  Now, with pregnancy and breastfeeding they are much larger.  So, sometimes I feel like I have all of the negatives of having had the surgery without enjoying the benefit of smaller breasts.  On the other hand, the years that I did enjoy having smaller breasts did wonders for my self-esteem and got me to the place where I am now, where I really don't feel self-conscious anymore.  I also think that breastfeeding my baby has changed the way I see my breasts forever.  My daughter loves my breasts: they comfort her when she is upset, they help put her to sleep, they fill up her tummy, they smell delicious.  It is as if I have finally discovered their true purpose.  Their size and shape no longer matter to me because their function brings me such joy.  

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