Whether to breastfeed is one of the most personal decisions a woman can make, and it isn’t always straightforward. Life and sometimes anatomy get in the way. Even in the best of circumstances, baby may have difficulty latching on or getting enough milk. Adding breast reduction surgery, also called a reduction mammaplasty, into the equation is no small matter and shouldn’t be taken lightly.

Many women who have had breast reductions have gone on to successfully breastfeed their babies, twins even. That said, if you are considering a breast reduction and have concerns about breastfeeding, make sure to discuss this with your plastic surgeon before surgery. Depending on your priorities, the goals you and your surgeon set may change, as may the surgical technique used. To navigate this issue, it is helpful to understand a little about the anatomy and physiology of the female breast.

How breastfeeding works

The breast, or mammary gland, is made up of fatty and glandular tissues, ligaments, nerves and blood vessels. Milk is produced in glandular structures called lobules and transported through a system of ducts, or channels, to the nipple. The nipple together with the darker skin around it is called the nipple-areola complex, and it plays a critical role in breastfeeding: Nerves in the area send signals to the brain to start milk production and flow; Small glands, similar to sweat glands, lubricate the nipple; and tiny muscles contract to support breastfeeding.

For most women, the amount of milk-producing tissue is the same, meaning women with larger breasts are not better at producing milk than women with smaller breasts. The amount of milk produced is more or less the same. The difference in size is due to the amount of fat and other non-milk producing structures in the breast.

Importance of goal setting

The impact of a breast reduction on the ability to breastfeed is most affected by the degree to which the nerves and milk-producing tissues are cut. This, in turn, depends on the amount of breast tissue removed to meet a woman’s goals. While these goals may be cosmetic, they may also be related to pain and dysfunction caused by overly large breasts. Read more about the many reasons women choose breast reduction.

Establishing your priorities and setting goals is an important part of planning any kind of plastic surgery, and that requires good communication with your surgeon. This is especially true for women of childbearing age who are considering breast surgery. If breastfeeding is a top priority, then your surgeon may advise you to wait until after you’ve finished having children.

Alternatively, instead of waiting you may decide to opt for a smaller reduction, if it means you are more likely to breastfeed.The size of the reduction, meaning the extent of tissue removed, the incisions required, and the technique used to move the nipple vary widely. Learn more about that in our post, What Exactly is a Breast Reduction?

Effect of surgical technique

Smaller breast reductions sometimes involve liposuction-only, but most require an incision at least around the nipple and often down toward the breast crease. The areola is usually reduced in size and moved higher on the chest. This can be done (and is, in most cases) while keeping the blood supply, nerves and milk ducts intact. In very large reductions, however, the nipple-areola complex may need to be detached completely and reattached similar to a skin graft.

According to a 2017 review of 51 research papers on breast reduction and breastfeeding, when the nipple-areola complex was kept attached, there was a 100 percent breastfeeding success rate. When it was left partially intact, breastfeeding was successful 75 percent of the time. And even when the nipple complex was completely detached, women were still able to successfully breastfeed 4 percent of the time.

Those research results are impressive and Dr. Slack has had good success with many patients breastfeeding after a reduction. But, none of that is a guarantee. Breast reductions come with some risk that breastfeeding will be affected. If this is important to you, the ability to have this conversation and ask the questions you need should be a big part of deciding which plastic surgeon is right for you.

To start that conversation, call our office in Allen, TX to schedule a consultation today.