That’s Not True! Common Myths About Lactation After Plastic Surgery
You’re conducting an initial exam with your new lactation client when you notice scars on their breast or chest that appear to be from a surgery. You know that previous surgical procedures may impact their lactation journey, but there are so many different procedures that people have, and so many different techniques. You’ve heard a lot of information, but how much of it is truly evidence-based?
Below, we’ll expose 10 common myths about lactation and plastic surgery procedures and leave you with just the facts. Our info is drawn from the vast expertise of our instructor, Katrina Mitchell, MD, IBCLC, PMH-C, FACS, and her course Plastic Surgery Procedures and Lactation. Mitchell is a fellowship-trained breast surgical oncologist and an IBCLC who cares directly for lactating parents, speaks internationally, and has developed a course on breastfeeding medicine for breast surgeons.
(Psst: Read all the way to the end for her top tips for supporting clients with previous surgeries, so you will know exactly how to proceed if the above scenario happens to you!)
LACTATION AFTER SURGERY: MYTHS & FACTS
Myth: Surgeons inform their breast/chest surgery patients about future impacts on lactation, so if someone had a previous breast surgery, they knew the risks.
Fact: There is currently no universal standardized consent addressing future lactation offered to patients who are having breast procedures. This means your client may be very surprised to learn that their previous surgery could impact their desire to provide milk to their baby.
Myth: People with previous breast surgery will struggle with lactation and probably won’t have a full milk supply.
Fact: Every post-surgical client’s lactation journey is different. Many parents with previous breast surgeries can absolutely provide their milk successfully to their babies.
Myth: Assessing your client’s scars during your breast exam is the best way to determine what kind of surgery they had.
Fact: You can’t tell what kind of surgery a client had by looking at their scars. Scars that appear to be from a breast lift/augmentation could actually be the result of a reconstructive procedure to address hypoplastic breasts – a very different underlying cause with very different implications for lactation. Your best move is to get full and complete medical history, including a surgical report.
Myth: Once you know your client’s type of surgery and the technique used, you can accurately predict their lactation experience.
Fact: Even for the same surgery performed with the same technique, lactation outcomes vary widely. Every surgery is unique, and every client has a unique medical history.
Myth: Lactation outcomes after plastic surgery are all about the 4th intercostal nerve.
Fact: The 4th intercostal nerve is important, but so are many other nerves. And, the role of the surgery’s impact on blood supply is just as important as its impact on nerves.
Myth: A client who has had breast reduction surgery won’t be able to lactate successfully if their milk ducts were cut during the surgery.
Fact: Once again, this is a huge-but-common over-simplification. The mammary gland has millions of ducts. Many are cut during most surgeries, but millions are left intact. The mammary gland is durable in its ability to produce milk.
Myth: Insufficient Glandular Tissue (IGT) is a useful medical term that tells you a lot about a client’s likely lactation outcome, and you can determine if it is present by breast shape and symmetry.
Fact: IGT is not a medical term. Hypolactation is the correct term to describe reduced ability to produce or secrete milk. Moreover, parents with tubular breast difference on exam are often able to produce plenty of milk — and asymmetry does not always result from absence of glandular tissue. Add to that the fact that the inclusion of the word “insufficient” in IGT can make parents feel like they or their body have failed, and this is a term you want to use very carefully. More research and better common definitions are definitely needed, so we are all speaking the same (respectful) language.
Myth: A client who has inverted nipples should consider having them surgically released to make latching easier.
Fact: Surgery to evert nipples causes vast disruption to the ductile tissue behind the nipple and significant scarring and is never advised as a way to improve lactation outcomes. Encouraging and allowing the restriction to release naturally via feeding is a much better bet.
Myth: Reliable research has shown that silicone implants can leak into breastmilk and harm babies, so parents with silicone implants should be counseled against providing their milk.
Fact: A group of flawed, pre-1992 studies reported higher levels of rheumatoid arthritis, scleroderma, and other health issues in children whose lactating parents had silicone implants. However, none of these studies tested the silicone levels of the breastmilk provided to subjects, nor did they confirm that the implants had ruptured. We do know that, in general, silicone is safe. There are higher levels of silicone found both cow’s milk and infant formula than in breastmilk, and a more recent, well-controlled study showed that when the breastmilk of subjects with silicone implants was compared with controls who did not have silicone implants, the silicone levels in the milk of the controls actually came out higher.
Myth: If a lactating parent’s silicone implant ruptures, they must stop providing their milk to their baby.
Fact: A parent with a ruptured silicone implant does not need to stop providing their milk to their baby. They should be counseled to see their doctor promptly for a true assessment of rupture, and you can support them to continue to provide their milk while the ruptured implant is removed. The same guidelines apply when a client has an infected implant, a much less common complication.
Bonus Myth: Since every post-surgical client’s case is so different, there are simply no guiding principles you can follow as a lactation care provider.
Fact: Yes, there are! Here they are:
KEY STEPS FOR SUPPORTING LACTATION AFTER PLASTIC SURGERY
Start early. Prenatal evaluation and support are key.
Avoid assumptions. Every case is unique and outcomes vary widely even among people who have had the same procedure.
Get as thorough a history as possible. This means a comprehensive medical history and a surgical report, including (if possible) pre- and post-op photos.
Make sure you understand why the surgery was undertaken. For example: Did your client who had an augmentation procedure opt for the surgery for exclusively cosmetic reasons, or did they choose it because they had markedly asymmetric breasts, suggesting a possible congenital anomaly? The lactation outcomes could be very different.
Help your client prepare for a range of lactation outcomes. Because each person’s course is unpredictable, talk through the possibilities and how they might want to handle them. If they are not able to supply all the milk their baby needs, what options for supplementing feel good to them? How would they want to do that?
Then help them define their own success. Exclusively feeding their baby their own milk is not the only path that can be rich and rewarding for them and their baby.
Support continuously & follow closely. Especially in the early days until milk supply is established and demonstrated, your care should include monitoring baby’s weight gain very closely and using weighted feeds to evaluate milk transfer.
Ready For More?
This course is included in our two-part Comprehensive Breast Care Conference, which also features the course Therapeutic Breast Massage in Lactation by renowned expert Maya Bolman. It’s 15% off through October 31, 2023! Use the coupon code Oct2023COTM at checkout.