Many women who have overly large breasts consider having breast reduction surgery. It is an extensive reconstructive form of plastic surgery that should be given a lot of thought. One consideration you should keep in mind is that even though many women breastfeed successfully afterward, breast reduction may interfere with future breastfeeding.
While there are many success stories, there is no guarantee that you will be able to breastfeed your baby or that you will be able to produce enough milk that you don’t need to supplement with formula.
Breast reduction is plastic surgery, but it is not always cosmetic surgery. A woman may want to reduce the size of her breasts for cosmetic reasons, such as having a more proportional figure, but having very large breasts can cause physical problems that make it a reconstructive procedure. These can include back and neck pain due to the weight of the breasts and recurring rashes under the breasts. Having very large breasts can cause mental health issues as well, such as diminished self-esteem and depression. Other non-cosmetic reasons to have breast reduction (also called reduction mammoplasty) are the difficulty and high cost of getting bras that fit you properly, discomfort during exercise, and the deep grooves that can develop on your shoulders from bra straps. Because breast reduction can be a necessity for health, health insurance may cover the costs of the surgery.
Nearly 100,000 people had either cosmetic or reconstructive breast reduction surgery in 2020, according to the American Society of Plastic Surgeons.
The surgery removes some fatty tissue, skin, and glandular tissue from the breast, which is the part of a breast produces milk and which is connected to the nipple by tiny tubes called milk ducts. There are several ways to perform breast reduction and the extent of the surgery can vary depending on the amount of tissue to be removed.
In addition to removing fat and glandular tissue, breast reduction surgery usually involves moving your nipples. In some types of breast reduction, the nipples are completely detached from the breast and reattached again higher up on the breast. In others, the nipples are kept attached to the milk ducts and are simply repositioned. A review of the medical literature done in 2017 found that when the nipple and areola are kept intact and just repositioned, the success rate for future breastfeeding was much greater than if the nipple was partially detached. If the nipple and areola are kept intact, the success rate for breastfeeding was as high as 100%. If they are kept partially intact, the success rate was about 75%. If the nipple and areola are detached during the surgery the breastfeeding success was about 4%. However, this means that even in cases where the nipple was completely detached and reattached, some women were able to produce breast milk.
Before your surgery, as part of the preliminary discussions with your surgeon, you should let him or her know that you want to breastfeed in the future. This will help your surgeon choose which surgical techniques to use. Ask the surgeon how many of his other breast reduction patients have successfully breastfed and what their experiences were.
If you decide to have a breast reduction, get a description of the type of surgery your surgeon performed and keep it for your records.
Although successful breastfeeding is more likely with many of the surgical techniques used today, there is still the chance that breast reduction may interfere with the amount of milk you produce. You may not be able to produce enough breast milk for your baby and may need to supplement with formula. Discuss the fact that you had breast reduction surgery with your obstetrician or midwife during prenatal care.
Speak with a lactation consultant who has helped other women who have had breast reduction surgery. A lactation consultant will talk to you about ways to determine if your baby is getting enough milk. If you aren’t producing enough milk, your consultant can teach you how to supplement your milk output with formula in a way that doesn’t decrease your supply. You can find a nearby lactation consultant or your obstetrician, midwife, or pediatrician can recommend someone.
Make sure to tell your baby’s pediatrician that you had breast reduction surgery and want to breastfeed. Your pediatrician may schedule more frequent weigh-ins to ensure your baby is meeting growth expectations and is getting enough nutrition.
If you are thinking about breastfeeding after any type of breast surgery, an excellent resource is the BFAR Information and Support page. BFAR stands for Breastfeeding after Reduction, but it covers all types of breast and nipple surgery. The webpage also provides information to health professionals about breastfeeding after breast surgery.