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defining your own successDefining Your Own Success:
Breastfeeding after Breast Reduction Surgery

by Diana West, BA, IBCLC
Available from the LLLI Online Store.

contents * about the author excerpt: introduction * reviews

Is it possible to breastfeed after breast reduction surgery? DEFINING YOUR OWN SUCCESS: BREASTFEEDING AFTER BREAST REDUCTION SURGERY by Diana West, IBCLC, is the only comprehensive resource on the market today that specifically addresses the questions surrounding the special circumstances of a woman who has had breast reduction surgery and wishes to breastfeed her children.

Most women who have had or are considering breast reduction surgeries are told in very uncertain terms that breastfeeding may or may not be a possibility for them. Some women are even told, most often incorrectly, that breastfeeding will be impossible following breast reduction surgery. In the past, this may have been more true but with advances in surgical techniques for reduction mammoplasty (breast reduction), surgeons are increasingly able to preserve milk-producing tissue so that women who have had breast reductions are able to breastfeed. Even so, however, many surgeons and health care professionals are still unaware of the effects these types of surgeries have on breastfeeding and are therefore unable to give the detailed answers and support these women need when they are ready to breastfeed their children. Unfortunately, in a day and age when the phenomenal and unmatchable benefits of breastfeeding are returning to the forefront of common knowledge and medical wisdom, many of these women feel forced to abandon breastfeeding in favor of exclusive formula feeding simply because no one around them knew enough about their specific issues to be able to educate them or fully support their efforts. The truth is most of these women are capable of breastfeeding and they should have the information they need in order to empower them to give their very best to their babies.

Written for the woman who has had or is considering breast reduction surgery and for the surgeons and other health care professionals who come into contact with her, this book provides detailed, critical information and valuable insights into BFAR specific issues. DEFINING YOUR OWN SUCCESS puts the challenges of breastfeeding after reduction into perspective. As West says, one of the most important views that this book strives to convey to mothers and health care professionals alike is that success:

" not an absolute term referring to a continuum of less to more breastmilk produced. Rather, it is defined by the degree of satisfaction each woman and her baby derive from the breastfeeding relationship they create together. It is not determined by the amount of milk a woman produces."

Whether she is able to produce a full milk supply or if she will supplement some of the nutrition that her baby needs, every woman can have a success story and every health care professional can learn how to support her in it.

Through pairing the most up-to-date research with the tried and true real life advice and stories from mothers who have come face to face with the realities of breastfeeding after breast reduction, Diana West discusses the following topics:

  • Reasons women have breast reduction surgery
  • A clear explanation of the anatomy and physiology of the mammary system
  • A discussion and illustrations of the most common breast reduction surgery techniques and each surgery's affect upon milk producing tissues
  • A discussion of the vast benefits of breastmilk and breastfeeding
  • The wide range of BFAR experiences along with many success stories as told by experienced post-breast-surgery, breastfeeding mothers
  • A thorough discussion of what a mother can feel and experience in her BFAR journey
  • How the BFAR mother can prepare for breastfeeding before her baby is born
  • A discussion of the practical mechanics of breastfeeding from the post-surgical perspective
  • How to maximize the milk supply and BFAR in the first few weeks postpartum
  • Methods of increasing milk supply, including pumping and galactagogues
  • Common breastfeeding problems from the BFAR perspective
contents * about the author *excerpt: introduction * reviews



Diana's Story
Part I
Before Birth: Contemplating Breastfeeding after Breast Reduction Surgery

Chapter One Why Women Have Breast Reduction Surgery
Physical Reasons
Psychological Reasons
Making the Decision to Have Breast Reduction Surgery

Louise's Story

Chapter Two Before and After: The Effect of Reduction Surgery on the Anatomy and Physiology of the Breast
Anatomy of the Lactating Breast
Exterior Anatomical Differences of the Breast after Reduction Surgery
Physiology of the Lactating Breast
Effects of Reduction Mammoplasty Surgical Techniques on Lactation

Vicki's Story

Chapter Three Why Breastfeeding is Worth the Effort
The Wonders of Human Milk
The Living Biochemistry of Human Milk
The Nutrition of Human Milk
Protection Against Disease
The Functional Benefits of Breastfeeding
The Maternal Benefits of Breastfeeding
A Mother's Pride

Sarah's Story

Chapter Four What to Expect
So What Will Your BFAR Experience Be Like?
The Range of BFAR Experiences
Determining Your Lactation Potential
Research Findings
Baseline Lactation Capability
Combinations of Feeding Methods
The Effort and Rewards of BFAR

Patti's Story

Chapter Five Preparing to Breastfeed after Breast Reduction Surgery
What You Can Do Before the Baby Is Born

Carol's Story

Part II
Baby Is Born: Maximizing Your Milk Supply and Developing Your Breastfeeding Relationship

Chapter Six Birth and BFAR Mechanics
Ensuring a Good Start
Beginning to Breastfeed
Establishing Your Milk Supply
The Influence of the Hospital and Health Care Professionals

Tracy's Story

Chapter Seven The First Month of BFAR
Nurturing Yourself
Tracking Your Baby's Progress
Evaluating Your Baby's Progress to Determine If Supplementation Is Necessary
Special First Month Concerns

Vanessa's Story

Chapter Eight Supplementing
When to Begin Supplementation
Human Milk Substitutes
How to Supplement
How Much to Supplement
Supplementation Devices

Wendy's Story

Chapter Nine Increasing Your Milk Supply
Psychological Techniques
Increased Demand Techniques

Janna's Story

Chapter Ten Breastfeeding Problems from the BFAR Perspective
Nipple/Areola Problems
Breast Problems
Baby's Problems
Mother's Problems
Overcoming Severe Difficulties

Misha's Story

Part III
Beyond BFAR: Evolving Your BFAR Relationship

Chapter Eleven BFAR and the Older Baby
How BFAR Changes as Your Child Grows Older
Supplementing the Older BFAR Baby

Jenifer's Story

Chapter Twelve Emotional Issues
A Wide Range of Emotions
Common Emotional Reactions
Emotional Reactions to Specific Situations
Baby Blues and Postpartum Depression
Coping Techniques
Your Identity As a Breastfeeding Mother

Lara's Story

Chapter Thirteen Defining Your Own Success
Exploring Your Feelings
Making Peace with Your BFAR Experience
Defining Your Own Success

Part IV
Assisting the BFAR Woman from the Professional Perspective

Chapter Fourteen Assisting the BFAR Mother from the Professional Perspective
All Healthcare Providers (HCPs)
Plastic Surgeons
Obstetricians and Midwives
Maternity Nurses
Lactation Consultants
LLL Leaders
Pediatricians and Pediatric Nurses
BFAR Topics for Future Research


Appendix 1 Support and Resources
Appendix 2 Weight Gain Chart
Appendix 3 Assessment Chart
Appendix 4 Relaxation Techniques
Appendix 5 What to Have On Hand Checklist
Appendix 6 Marmet Technique-Manual Expression of Breast Milk



contents * about the author *excerpt: introduction * reviews

About the Author

Diana West, author

Diana West, BA, IBCLC

Diana West is an international board-certified lactation consultant (IBCLC) and author of "Defining Your Own Success: Breastfeeding After Breast Reduction Surgery," (LLLI, 2001) and co-author with Lisa Marasco of Making More Milk: A Nursing Mother's Guide to Milk Supply (publication TBA). She is a frequent speaker at breastfeeding conferences throughout North America, a website developer and administrator, and a retired La Leche League Leader. She raises guide dog puppies for the Seeing Eye and mothers her three charming, breastfed sons in partnership with her husband Brad in their home in New Jersey.

contents * about the author *excerpt: introduction * reviews

An Excerpt from DEFINING YOUR OWN SUCCESS: Introduction

When asked whether it is possible to breastfeed after breast reduction surgery, most people will automatically answer that it probably is not. Many women who have had breast reduction surgery do not even consider breastfeeding and bottle-feed their babies from birth onward. Other women who have had breast reductions try to breastfeed, but are ultimately unable to, perhaps because the surgical damage to the breast was too severe. But often it is simply that these women lacked adequate information and support. Increasingly, however, women who have had breast reduction surgeries are defying conventional wisdom and successfully breastfeeding their babies.

In addition to co-founding a resource center for breastfeeding after breast reduction surgery and working with hundreds of breastfeeding women in my capacity as a La Leche League Leader, I breastfed my three children with increasing success. My professional and personal experiences have convinced me that it is possible to breastfeed after breast reduction surgery if three factors are present:

  • At least one breast and nipple;
  • information; and
  • support.

While the first is obviously necessary, I firmly believe it is the latter two factors, information and support, that are the most critical predictors of a post-surgical woman's chances of developing a satisfying breastfeeding relationship. Far more women are forced to abandon breastfeeding in favor of formula-feeding not because these women are physically incapable of producing milk, but because no one around them knows enough about the issues involved to be able to educate them or fully support their efforts.

If you are one of those women who was told that breastfeeding was impossible after breast reduction, you may be pleasantly surprised to learn that the ability to produce milk, in and of itself, is not a criteria for having a successful breastfeeding relationship. This book defines a breastfeeding relationship as one in which the baby is fed a regular portion of his nutritional requirement at the breast. So, although many post-breast surgical women may need to supplement in varying degrees, at or away from the breast, there are few instances wherein breastfeeding cannot be a very important and beneficial part of the mother-child relationship.

Among women who have had breast reduction surgery and are now breastfeeding, it is often said that "We each define our own success." As it is used here, "success" is not an absolute term referring to a continuum of less to more milk produced. Rather, it is defined by the degree of satisfaction each woman and her baby derive from the breastfeeding relationship they create together. It is not determined by the amount of milk a woman produces. Each woman's experience of success will be different; some may be able to breastfeed exclusively, while others may need to supplement the baby's entire nutritional requirement. But even those women can supplement their babies at the breast, much like an adoptive breastfeeding mother does.

It is important to remember that breastfeeding is much more than nutrition. By breastfeeding our babies, we fulfill a wide range of their emotional needs. When we understand success in this way, we are aware of the power we have to make breastfeeding possible and to be wholly satisfied with whatever unique direction our breastfeeding relationship may take. It is this empowerment that gives us strength in vulnerable moments and keeps the knowledge uppermost in our minds that we alone determine what success will mean for us. This book has been written to provide the critical information and support so that any woman who has had a breast reduction and wants to breastfeed can do so.

What is BFAR?

As the techniques of breast reduction surgery evolved over the past several decades, the viability of breastfeeding correspondingly increased. The earliest techniques were so injurious to the ducts and glands of the mammary system that breastfeeding was patently impossible. Surgeons steadfastly warned prospective surgical patients that it would not be possible for them to breastfeed. Increasingly, however, surgical advances were made that better preserved the mammary system so that by the late 1980s, surgeons were able to tell prospective patients that breastfeeding after the surgery may be possible. Only a few very confident and optimistic surgeons asserted that breastfeeding would be completely unaffected by the surgery.

These assessments of the future viability of breastfeeding, however, no matter how guarded, frequently gave unrealistic and inaccurate expectations to women who often had little knowledge of the importance of breastfeeding or how they would feel about it when they became mothers. In the late 1980s, when lactation professionals began seeing women who had had breast reduction surgery attempt to breastfeed, they found that their clients experienced varying degrees of success and, frustratingly, they had little information with which to help them.

Indeed, few resources exist for the many women who have had breast reductions and are now attempting to breastfeed. As most other BFAR mothers have done, I began my journey into the breastfeeding world by looking for any information at all on breastfeeding after breast reduction surgery. Other than scant paragraphs here and there, basically advising that one would only know if lactation was possible by putting the baby to the breast and seeing how it went, I could find nothing that addressed the many issues that surrounded my unique situation. My doctor, midwives, pediatrician, and lactation consultant were also inexperienced with this particular realm of breastfeeding.

I became very fortunate in January of 1996 when I met four other women who had had breast reductions on the Internet through bulletin boards and email lists - Carol Maranta, Lara Cowan-Vesper, Colleen Dunhill Jones, and Christine Gilmore Eubanks. We were amazed to find each other and decided to begin a private correspondence through email, so that we could compare our experiences and learn from each other. Eventually, other women wanted to join us so we began an automated email list. The list has grown to average two hundred active subscribers as of the writing of this book.

By combining and comparing our information we learned what worked and what didn't. The wealth of information that the members of the email list were able to collect from their experiences was tremendous. We passed along this information to new members and provided a forum of wholehearted support for the unique challenges we were facing; the email list became a tremendous resource.

All email lists need a descriptive and memorable name, and we decided to call ours BFAR, pronounced "bee-far," which is an acronym derived from BreastFeeding After Reduction. Over time, the term BFAR came to mean not only the email list, but we also began to use it as a part of our vocabulary as we discussed the issues surrounding our various experiences. Colloquially, the term BFAR is used on the email list as an actual word that can be conjugated to noun and verb forms. In this book, however, the use of the term BFAR will be restricted to that of an acronym without conjugations, so that the words for which it stands - Breastfeeding After Reduction - are inferred when it is used. The term does not infer any membership or association with the BFAR email list.

Aside from the prerequisite of having had breast reduction surgery, BFAR is defined most simply as feeding a baby at the breast with or without human milk, as well as feeding a baby your own milk with an artificial feeding device, such as a cup, syringe, or bottle. This definition is very broad because it encompasses many combinations of feeding methods. The important point is that while any amount of lactation qualifies as BFAR, a woman need not lactate to be a BFAR mother as long as she is feeding her baby at the breast.

For Whom This Book Is Written

This book has been written first and foremost for you, the BFAR woman, to provide you with a composite of information about BFAR, as well as empathy and encouragement to help you through any BFAR issues you may encounter. Whether you are just beginning to consider the possibility of BFAR, or are pregnant for the first time and faced with critical choices, or contemplating BFAR your second, third, fourth, or even ninth baby, the prospect of BFAR can seem like a daunting challenge. But with this book in hand you are armed with an advantage that wasn't available to you before. You will see that BFAR is possible.

If you are dedicated to providing the benefits of human milk and breastfeeding for your child, this book will provide you with the information and support to make breastfeeding a reality for you. You'll find support through validation of your feelings about BFAR and encouragement of your efforts to make it work for you and your baby. You'll read about the experiences and feelings of many BFAR women who have generously shared their stories to illustrate the wide range of experiences that are possible.

In addition to providing encouragement and support, this book is a concentrated compilation of the information collected through the research and experience of many dedicated lactation specialists over the past decade. I have reviewed the available information about BFAR, applied logic and common sense, and then observed the personal trial and error of many BFAR women to determine what is effective and what is not.

Of course, it must be said that no two BFAR experiences are alike, even for the same woman. Each woman and each birth has a different combination of factors that comprise her BFAR challenge. Some of these factors are physiological, some are psychological, and some are environmental. It is no more possible to address every situation that a BFAR mother might face than it is to promise that every BFAR mother will be able to avoid supplementation. Both would be unrealistic. What this book can do, however, is speak to the common denominators that we have all seemed to encounter, and address as many of the issues that a typical BFAR mother might face as possible. Readers are always encouraged to contact their local La Leche League Groups for further information.

Because each woman and each set of BFAR circumstances is unique, this book cannot provide a definitive recipe for BFAR success. The techniques that work for another BFAR mother are not always the best solution for you. You will not find any promises that if you do "X," "Y," and "Z" you will have a certain outcome. Breastfeeding is an art, not a rigid mechanical method; it must be adapted to the special needs and temperaments of each mother and her baby.

While the BFAR woman is this book's primary focus, it has also been written to assist health care professionals-including physicians, midwives, maternity and pediatric nurses, lactation consultants, WIC counselors, and La Leche League Leaders-in helping the BFAR woman achieve a satisfying breastfeeding experience. In the past, these professionals have been at a disadvantage, having no resources and scant research from which to draw information to help their BFAR clients. It has been very difficult for them to advise BFAR women at all. Conventional wisdom, common sense, and knowledge of the principles of lactation have been their only tools. This book, therefore, is intended to become the resource previously unavailable to the professional. While many chapters, such as those discussing basic anatomy and reduction surgeries, will be elementary to professionals, other chapters will provide practical information that can be utilized to assist the BFAR client. This book is intentionally comprehensive in scope so that the many aspects of lactation can be presented and considered from the BFAR perspective.

Finally, you may notice that all babies are referred to in the masculine gender. This has been done only for the sake of simplicity and it is hoped that all the sweet little girl babies will be forgiving.

What This Book Will Cover

Wonderful books, such as La Leche League International's THE WOMANLY ART OF BREASTFEEDING, as well as The Nursing Mothers' Guide to Breastfeeding, by Kathleen Huggins and Linda Ziedrich, Nursing Your Baby by Karen Pryor and Gale Pryor, and Bestfeeding by Mary Renfrew, Chloe Fisher, and Suzanne Arms, have been written to address normal breastfeeding issues and concerns. This book complements these comprehensive resources by further addressing the unique circumstances of BFAR. BFAR women are encouraged to obtain a copy of at least one of the books listed above in addition to this book so that you may have a thorough understanding of normal breastfeeding.

Where this book differs, though, is in its approach to each aspect of breastfeeding from the BFAR perspective. The experiences of hundreds of BFAR women have been examined so that it will be possible to discuss the issues common to all of us, as well as those encountered by only a small segment of the BFAR population.

This book has been divided into four sections. The first, Part I, is "Before Birth: Contemplating Breastfeeding after Breast Reduction Surgery." In these five chapters, the issues and information that provide the framework for considering the viability of BFAR are discussed.

Part II, "Baby Is Born: Maximizing Your Milk Supply and Developing Your Breastfeeding Relationship," explores the unique issues BFAR women confront when they begin breastfeeding and the specific methods of BFAR that maximize the milk supply while enabling the new mother and baby to bond at the breast.

"Beyond BFAR: Evolving Your BFAR Relationship," addresses BFAR after the first three months, explores common BFAR emotional issues, and facilitates an assessment of factors that help and hinder the BFAR effort.

The final section, Part IV, "Assisting the BFAR Woman from the Professional Perspective," addresses the professional caregiver, providing specific information according to professional specialty to those who assist the BFAR patient.

The Appendices include additional charts, checklists, and resources.

Following each chapter, you will read the stories of women who were able to breastfeed following breast reduction surgery, in their own words. They generously shared their stories so that you can gain insights into this experience and learn how they weathered challenges that you may also face. These first BFAR mothers were courageous pioneers-women who defied convention and the discouraging advice of so many professionals to give their own milk to their babies-and it is they who have provided the body of knowledge that makes the success of today's women possible.

As you read these stories, keep in mind that no two BFAR situations are alike. The physiological capabilities, the circumstances, prior knowledge, even the personality of the mother and baby, greatly influence the BFAR experience. Most importantly, these mothers were attempting to breastfeed in a time when very little was known about it and so their efforts were greatly trial-and-error. They had no real way to prepare for BFAR and they did not have accurate information upon which to base their decisions. Although you may have much in common with several of the experiences described here, with this book in hand you will have much better information to help you prepare for BFAR so that you will maximize your lactation potential and avoid much of the emotional trauma that these valiant BFAR pioneers endured.

Define Your BFAR Success!

From my own experience and from having known many other BFAR women, I am aware that many women who have never been exposed to breastfeeding before may be completely overwhelmed at the prospect of BFAR. These women need support and at least one comprehensive resource for information in order to address this unique experience that can seem to isolate them from the rest of the breastfeeding world.

Ultimately, it is the objective of this book that each person who reads it is left with a conviction that a BFAR mother can breastfeed her baby. With this understanding, every BFAR mother can then define her own success, no longer thinking of breastfeeding in terms of "all or nothing," but rather knowing that any amount of human milk given to a child is valuable beyond measure and worth any effort it may take to produce it.

This book carries one message on every page: Whether you are the professional or the BFAR woman herself, no matter what the physiological capability, you can make the difference . . . you can make it happen . . . you can give a baby the precious gift of a breastfeeding relationship.

contents * about the author *excerpt: introduction * reviews


From The Journal of Human Lactation, the official journal of the International Lactation Consultant Association (ILCA), Volume 18, Number 2, May 2002, page 183 -- Reviewed by Heather Chase, MS, IBCLC

In Defining Your Own Success: Breastfeeding After Breast Reduction Surgery, Diana West defines breastfeeding as much more than human milk and infant nutrition. She understands the broad benefits for the mother and child and their breastfeeding relationship. The audience for this important work is women who have had breast reductions and desire to breastfeed or are breastfeeding. It is written for women contemplating breast reduction surgery prior to the completion of their childbearing years, and yet it is an excellent resource for health care professionals, in particular lactation consultants.

This book is divided into 4 sections with 14 chapters. In Part 1, Before Birth: Contemplating Breastfeeding After Breast Reduction Surgery, 5 chapters describe the anatomy of the breast and types of surgery common in breast reduciton procedures. Why women choose to have this surgery, both physical and psychological, are discussed. Part II, Baby is Born: Maximizing Your Milk Supply and Developing Your Breastfeeding Relationship, contains a chapter that covers supplementing in a "guilt-free" manner. The very important Part III: Beyond Breastfeeding After Reduction: Evolving Your Breastfeeding Relationship, discusses the array of emotions and feelings a woman may experience after breastfeeding after reduction (BFAR). The only chapter of Part IV, The Professional Perspective, discusses the ways in which health care professionals can assis the mother who is breastfeeding after reduction. An appendix with a wealth of resources concludes the book.

West does a remarkable job of presenting complex scientific information in a straightforward, accurate, and easily understood terms. Without giving unrealistic expectations with regard to milk supply, she gives value to the process of breastfeeding itself. Between each chapter are individual stories written by BFAR women, with varied degrees of "success." These experiences demonstrate that it is up to the mother to define her own breastfeeding success.

Practical addvice is plentiful. Among others, West provides great tips for monitoring input and output in the early postpartum period. She gives advice on how to choose health care providers who will initiate support for the BFAR woman prior to delivery.

I have seized the opportunity to recommend this book to each and every BFAR woman in my consultation practice.

From "The Parenting Shelf" in the October 12, 2001 issue of Reviewer's Bookwatch

Defining Your Own Success: Breastfeeding After Breast Reduction Surgery is specifically written to enable mothers who have had breast reduction surgery to breastfeed their babies. Though breastfeeding after such surgery is generally thought impossible, recent advances in reduction surgery techniques now allow lactation capabilities to be better retained than in the past. Trial and error experience combined with knowledge has allowed thousands of post-surgical women to breastfeed in spite of the obstacles. Defining Your Success explicitly describes how to maximize a woman's milk supply and confront challenges. A special section is also devoted specifically to the professional perspective, from health care providers to plastic surgeons and maternity nurses. Personal anecdotes and several appendices round out this well thought-out reference. Highly recommended.

From NEW BEGINNINGS, Vol. 18 No. 6, November-December 2001, p. 222 -- Reviewed by Unity Dienes

contents * about the author *excerpt: introduction * reviews
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