1. Breast Feeding After Breast Surgery Alganesh Kifle BSN IBCLC NICU Lactation Coordinator

2. Breast Surgery Likely to Cause Breastfeeding Problems According to the Institute of Medicine (National Center for Health Research). “Any kind of breast surgery, including breast implants surgery, makes it at least three times more likely that a woman trying to breastfeed will have an inadequate milk supply “. ( In a study by Nancy Hurst from Texas Children’s Hospital). 64%of women with breast implant had lactation insufficiency compared to 7% of women without.

3. Breast feeding After Breast Surgery Objectives: Assist and support a mother who wishes to breastfeed after breast surgery Identify the impact of breast surgery on breast milk supply and to assess ineffective breast feeding due to nipple trauma and loss of milk ejection To encourage the mother to express her feeling and to anticipate her unspoken fears Provide ongoing assessments through follow up until optimal milk supply is achieved

4. Breast Injury and Surgery Reduction Mammoplasty — likely to have difficulty producing enough milk, especially with periareolar incisions Augmentation Mammoplasty — compatible with successful breastfeeding Lumpectomy — may affect breastfeeding if significant nerves or ducts have been removed Previous Treatment for Breast Cancer — radiation after lumpectomy may interfere with lactation. Mother can usually breastfeed on an unaffected breast Trauma and Burns — varies, but many people with severe trauma and burns to the breast have been able to breastfeed with success Pierced Nipples — not associated with breastfeeding difficulties. Nipple devices should be removed before feeding

5. Breast Implant Saline and silicon filled implants.( FDA, 2006. 2013 ) For possible successful breast feeding there should be no interruption of nerve or blood supply to the glands, milk ducts or nipple.( Labbok, Global Breastfeeding Institute )

6. Breast Augmentation Technique 1.Peri areolar technique 1.Infra sub mammary 1.An axillary incision 1.An incision made around the nipple and areola. Although there is no visible scar there is often loss of nipple sensation 2.An incision under the breast for implant placement. Disadvantage is that the scar is visible and easily irritated by a bra 3. An incision made underneath the arm placing the implant below the gland or muscle. It has minimal effect unless pressure on the nerve pathway and ducts

7. Breast Reduction Mammoplasty Exclusive breastfeeding might not be possible after reduction. ( Human lactation, Harris, stevens, et Frieberg). However, mothers have the best chance of lactation with the least amount of breast tissue and milk duct being removed. Also, if the fourth intercostal nerve that branches to the breast and areola is left intact there can be a sign of milk ejection.

8. Techniques of Breast Reduction

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10. Length of Time Between Surgery and Subsequent Pregnancy Despite the type of surgery a woman may seem to have a better milk supply when her surgery occurred five or more years before her pregnancy(West, 2002) The two processes are: Recanalization – where in breast tissue actually regrows, reconnecting previously severed ducts. Reinnervation – the process whereby the nerves that were damaged by surgery are regenerated. Regeneration of such nerves would be a key component of increased lactation capacity

11. Establishment of Breastfeeding —Hormonal Control Prolactin signals alveolar production of milk Oxytocin causes milk to be ejected into the duct system (“let down”) Feedback Inhibitor of Lactation (FIL) – small whey protein whose presence decreases milk production Effective, frequent emptying of the breasts is essential to milk production Breast is full Breast is emptier Presence of FIL slows milk synthesis Less FIL present speeds up milk synthesis Feedback Inhibitor of Lactation

12. Lactation Management for BFAR and Augmentations Early prenatal lactation information Referral to a Lactation consultant upon admission Assisting mother during First Hour skin to skin and breastfeeding Teaching the mother cue based feeding, feeding on demand and the use of Supplemental Nursing System If mother and baby are separated,assist mother with hand expression of colostrum and follow up on her milk supply. May use a milk pump log. Provide on going support. Obtain an electric breast pump, referral to community services WIC and follow up with “ Bridge Program” when applicable

13. Conclusion Advocate for the mothers breastfeeding rights! Provide realistic information to breast feeding mothers during perinatal period Inform the mother to anticipate initiation period the First Hour “Golden Hour” Skin /Skin/ breastfeeding Prevent Filling Inhibitor of Lactation due to delayed Lactogenesis II Maintain Lactogenesis III continuation of milk production, option of medically indicated supplement Every drop of human milk is a precious enduring treasure for a child therefore continuous support is imperative

14. THANK YOU

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19. Breast Feeding After Reduction (BFAR) Augmentation

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23. Breast Reduction Mothers should be encouraged to breastfeed early and frequently to stimulate the breast to provide as much breast milk as possible Babies might need to be supplemented Supplementation can often be done at the breast with a tube feeding device so that the mother and bay can enjoy each other and the breastfeeding experience