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BTW different topic

here: Have a mom with a breast " lift " says it is

not reduction - I say it doesn't matter how much or what they took out if

they cut her. She also had a gastric by pass a few years ago and

lost alot of weight. We are trying it all - power pumping, herbs,

and she even went to a dr (specializing in lactation) to learn about

domperidone. She produces maybe one ounce a day. Just wondering if

anyone had any experience with both breast surgery and gastric by pass.

A breast lift, also known as mastopexy, typically does not impair nerve

or ductal functionality because the incisions are only in the epidermal

layers. This is not to say it can't happen. One also has to

wonder, though, about the underlying causes of the obesity that required

the gastric bypass. Does she have an insulin resistance

issue? Is there any hypoplasia?

This is what we have and I have in our new book about gastric bypass

(subject to editing and revision):

<H3>Gastric Bypass Surgery<H3>

With the rise in surgical treatments for obesity, breastfeeding after

gastric bypass surgery is raising questions in the lactation community.

Cases of low milk production have been reported by lactation consultants,

but the medical literature currently reflects only problems with B-12

deficiency in some patients’ milk.

According to Arnetta Dailey, RN, IBCLC, a lactation consultant who works

with gastric bypass patients, these women are often encouraged by their

doctors not to become pregnant for at least one and a half to two years

after surgery so that they can complete their most rapid period of weight

loss and resultant high level of ketosis prior to

pregnancy.[ii] Waiting to become pregnant also

gives their stomachs time to heal and stretch.

[iii] In addition, it has been her observation

that when these women become pregnant too soon, they seem to have a

higher rate of small umbilical cords and significantly premature

deliveries. Most women in the rapid weight loss phase are taking in as

little as 300 calories a day, making it difficult to consume enough

essential nutrients to adequately support pregnancy and lactation.

..

There are several different types of gastric bypass surgeries, each with

different possible effects on the absorption of nutrients from food.

Women with Roux-En-Y procedures are at higher risk for deficiencies in

calcium, folate, vitamin B-12, iron, and protein malnourishment and

should therefore seek nutrition counseling during pregnancy and

lactation.[iv]

Generally speaking, Arnetta Dailey has found that those mothers who have

had a gastric bypass and go on to consume at least 70 grams of protein

per day along with vitamin supplements do not seem to have trouble making

milk.[v] However, reports are still scarce.

One mother experienced significant problems with milk production until

she researched the nutritional impact of her surgery and had her B-12 and

zinc levels tested. Her zinc was considered low and her B-12 was “very

low-normal.” Having discovered that this could still be a problem, she

began taking supplements of both nutrients and her milk production

increased to normal levels.

Low milk production after gastric bypass surgery may also be related to

pre-existing hormonal conditions associated with obesity. This

possibility should be considered, along with potential effects of the

surgery itself, when evaluating low milk production problems after bypass

surgery.

Wardinsky, T., Montes, R., Friederich, R., et al.

Vitamin B12 deficiency associated with low breast-milk vitamin B12

concentration in an infant following maternal gastric bypass surgery.

<I>Arch Pediatr Adolesc Med<I> 1995 Nov; 149(11):1281-4.

[ii] Ferraro, D. Management of the bariatric surgery

patient: lifelong postoperative care [board Review]. <I>Clinician

Reviews<I> 2004; 14(2):73-80.

[iii] Dailey, A. Personal communication with

Marasco. August 2004.

[iv] Fussy, S. The skinny on gastric by-pass: What

pharmacists need to know. U.S. Pharmacist 2005;2:HS-3-HS-12.

http://www.uspharmacist.com/index.asp?show=article & page=8_1438.htm

Accessed July 31, 2005.

[v] Dailey, A. Personal communication with

Marasco. August 2004.

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