by Anne Eglash MD, IBCLC, FABM

Is there a surgical breast reduction technique that results in less risk for low milk supply? According to the authors of a systematic review of the impact of breast reduction on breastfeeding breast reduction surgery is the 8th most common plastic surgery procedure world-wide, with nearly half-million performed in 2015. It is difficult to evaluate the optimal breast reduction surgical technique for breastfeeding preservation because among the 51 articles reviewed for this research, 102 different breast reduction techniques were used, and the measurement of breastfeeding success varied greatly. Most articles did not describe the details of breastfeeding success, such as volume of supplementation. Nevertheless, there were some trends noticed in the research.

What do you think are accurate statements according to these authors regarding the effect of breast reduction surgery on breastfeeding success? (choose 1 or more)

  1. Preserving the breast tissue beneath the nipple-areolar complex is associated with greater likelihood of breastfeeding success.
  2. Keeping the nipple/areolar complex intact is associated with greater likelihood of breastfeeding success.
  3. Studies that evaluate breastfeeding rates for more than 12 weeks postpartum demonstrate less breastfeeding success.
  4. Studies that focus more on the details of breastfeeding success demonstrate less breastfeeding success.
  5. More than 50% of the studies identified ‘any’ breastfeeding as breastfeeding success.
  6. There is little research to tell us what breast reduction techniques are most commonly offered to women of child-bearing age.

See the Answer

 
Answers – All

Read the Abstract

The impact of breast reduction surgery on breastfeeding: Systematic review of observational studies

Roni Y. Kraut Erin Brown , Christina Korownyk , Lauren S. Katz , Ben Vandermeer , Oksana Babenko , M. Shirley Gross , Sandy Campbell , G. Michael Allan
PLOS one October 19, 2017

Almost half a million breast reduction surgeries are performed internationally each year, yet it is unclear how this type of surgery impacts breastfeeding. This is particularly important given the benefits of breastfeeding.

Objectives
To determine if breast reduction surgery impacts breastfeeding success and whether different surgical techniques differentially impact breast feeding success.

Methods
Databases were searched up to September 5, 2017. Studies were included if they reported the number of women successful at breastfeeding or lactation after breast reduction surgery, and if they reported either the total number of women who had children following breast reduction surgery, or the total number of women who attempted to breastfeed following surgery.

Results
Of 1,212 studies, 51 studies met the inclusion criteria; they were located worldwide and had 31 distinct breast reduction techniques. The percentage of breastfeeding success among studies was highly variable. However, when analyzed by the preservation of the column of parenchyma from the nipple areola complex to the chest wall (subareolar parenchyma), a clear pattern emerged. The median breastfeeding success was 4% (interquartile range (IQR) 0–38%) for techniques with no preservation, compared to 75% (IQR 37–100%) for techniques with partial preservation and 100% (IQR 75–100%) for techniques with full preservation.

Conclusions
Techniques that preserve the column of subareolar parenchyma appear to have a greater likelihood of successful breastfeeding. The preservation of the column of subareolar parenchyma should be disclosed to women prior to surgery. Guidelines on the best breast reduction techniques to be used in women of child bearing years may be advantageous to ensure women have the greatest potential for successful breastfeeding after breast reduction surgery.

Milk Mob Comment by Anne Eglash MD, IBCLC, FABM

All of the answers are correct. There are no expert policies or protocols that guide plastic surgeons on what breast reduction techniques are optimal to minimize their negative impact on breastfeeding.

My personal opinion is that there are several factors that impact breastfeeding success among women who have had breast reductions, such as pre-pregnancy BMI, amount of glandular tissue present before surgery, age, number of lactational episodes after breast reduction, type 2 or gestational diabetes, and polycystic ovarian syndrome, for starters.

This study is helpful because it gives us some degree of guidance on how to counsel women seeking a breast reduction, who would like to breastfeed.

Unfortunately, there are many women with a history of a breast reduction as a teen, who fly under the radar during pregnancy and postpartum, with no one knowing about their breast reduction history. Clearly this is a set-up for disaster because from my experience, I estimate a 10% likelihood of exclusive breastfeeding success among women with a breast reduction. I counsel women with a history of breast reduction that no matter the technique, she is at significant risk for insufficient milk supply, and I emphasize the need to follow the infant’s weight closely during the first few months postpartum.

Comments (3)
Leave a Comment
Comments are moderated
Your email address will not be published. Required fields are marked *

Comments are closed for this question.