Re: BF after augmentation

[Guest guest]

It's absolutely a wait and see. You really won't know anything for sure until after the birth... Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/Facebook: www.facebook.com/thesecond9months--- Subject: BF after augmentationTo: "" < >Date: Saturday, April 2, 2011, 5:40 PM

I'm working with my first augmentation client, which seems hard to believe. I'm actually working with her as her doula, but she mentioned to me that her midwife isn't sure if she can breastfeed, but that her doctor assured her she should be able to. She's 8 months pg now and had the augmentation maybe a year ago or so? She wants to breastfeed. She mentioned that her breast size was smaller than an A before and I wonder about insufficient ducts to start. Her MW told her that she didn't think she had "enough milk ducts" to breastfeed, so I've asked her at our next appt if there's any way I can see her pre-op photos to see if I can get an idea of what they looked like before since it's impossible to tell now. She said they weren't asymmetrical, but we'll see. What else should I be looking for with photos? Anyone know? I know this may be a "we'll see" situation and I may not be able to tell just by looking at photos, but I know the photos from

our lactation texts. I do provide lactation services as part of the doula package, so I will be working with her beyond birth to see breastfeeding to a good start, as I usually do with my clients.

Thanks in advance for any thoughts you may have about this.

, IBCLC, RLC, Labor Doula

Mother Nature Birth & Lactation

http://www.mothernaturelactation.com

Connect on Facebook: http://www.facebook.com/theerinmoore

[Guest guest]

, You can ask her if she feels that her breast have increased in size during her pregnancy. Glandular tissue in the breasts will respond to pregnancy hormones and multiply in order to get ready for the baby’s birth.  Usually, this is a good sign for lactation if the breast grew. Keep us posted. Ghislaine Reid, BA (Translation 1981), LLL (1990), IBCLC(2002)Montreal, Quebec, Canada De : [mailto: ] De la part de , IBCLCEnvoyé : 2 avril 2011 20:40À : Objet : BF after augmentation I'm working with my first augmentation client, which seems hard to believe. I'm actually working with her as her doula, but she mentioned to me that her midwife isn't sure if she can breastfeed, but that her doctor assured her she should be able to. She's 8 months pg now and had the augmentation maybe a year ago or so? She wants to breastfeed. She mentioned that her breast size was smaller than an A before and I wonder about insufficient ducts to start. Her MW told her that she didn't think she had " enough milk ducts " to breastfeed, so I've asked her at our next appt if there's any way I can see her pre-op photos to see if I can get an idea of what they looked like before since it's impossible to tell now. She said they weren't asymmetrical, but we'll see. What else should I be looking for with photos? Anyone know? I know this may be a " we'll see " situation and I may not be able to tell just by looking at photos, but I know the photos from our lactation texts. I do provide lactation services as part of the doula package, so I will be working with her beyond birth to see breastfeeding to a good start, as I usually do with my clients.Thanks in advance for any thoughts you may have about this. , IBCLC, RLC, Labor DoulaMother Nature Birth & Lactationhttp://www.mothernaturelactation.comConnect on Facebook: http://www.facebook.com/theerinmoore

[Guest guest]

If you look at the Breastfeeding Atlas you can see some photographs of women who

have the appearance of insufficient glandular tissue and have both normal and

abnormal lactation outcomes.

There is a difference between developed small breasts and underdeveloped breasts

with IGT. I worked with a woman once who was on her 3rd baby and described

classic low supply from IGT, when I examined her breasts she clearly had

underdeveloped breasts, like the photo seen in the Atlas. She said she had been

told " ...women with small breasts can make plenty of milk " , which I completely

agree with, but she did not have small breasts, she had completely

underdeveloped breasts with no LactII. The first question I ask is appearance

of preaugmented breasts, which you've established. Sounds like she may have been

correcting a pre-existing condition that may or may not be IGT. I would also ask

her about the technique used for the procedure, where are the incisions for the

placement which may play a role in her future outcome. Lact I is usually normal

for this group, it's just Lact II that they may struggle with. I don't find

midwives and physicians very accurate with their prenatal assessments. I can't

tell you how many times I've seen women with classic hypoplasia or

underdeveloped breasts and check their H & P and see the prenatal breast

assessment identified as normal.

I had a midwife very angry with me because I had discussed this with one of her

patients who was on her 2nd baby, and had classic hypoplastic breasts, previous

child, low supply, no Lact II, excessive weight loss, jaundice, no milk with

added pumping etc. She chastised me that her patient's breasts were 'perfect and

normal'! Well, I don't use language that is disempowering so I wouldn't tell a

woman her breasts are 'abnormal' however I did compassionately discuss this

possible condition with her client, who was actually relieved that her

breastfeeding struggles were in fact not due to her mismanagement of

breastfeeding most likely the result of an authentic physiologic condition (she

did have follow up and again no Lact II)... I went and got my Atlas and showed

it to the midwife , she humbly confessed she had no idea about the photos of

hypoplasia, I gave her my old edition for her office.

If her breasts were developed yet simply small and the incision is not in a

place of interference she should have a decent outcome. It is that wait and see

though, let us know how it turns out!

>

> I'm working with my first augmentation client, which seems hard to believe.

I'm actually working with her as her doula, but she mentioned to me that her

midwife isn't sure if she can breastfeed, but that her doctor assured her she

should be able to. She's 8 months pg now and had the augmentation maybe a year

ago or so? She wants to breastfeed. She mentioned that her breast size was

smaller than an A before and I wonder about insufficient ducts to start. Her MW

told her that she didn't think she had " enough milk ducts " to breastfeed, so

I've asked her at our next appt if there's any way I can see her pre-op photos

to see if I can get an idea of what they looked like before since it's

impossible to tell now. She said they weren't asymmetrical, but we'll see. What

else should I be looking for with photos? Anyone know? I know this may be a

" we'll see " situation and I may not be able to tell just by looking at photos,

but I know the photos from our lactation texts. I do provide lactation services

as part of the doula package, so I will be working with her beyond birth to see

breastfeeding to a good start, as I usually do with my clients.

>

> Thanks in advance for any thoughts you may have about this.

>

> , IBCLC, RLC, Labor Doula

> Mother Nature Birth & Lactation

> http://www.mothernaturelactation.com

> Connect on Facebook: http://www.facebook.com/theerinmoore

>

[Guest guest]

what michelle said. Yes, often HCP's really don't know about breasts at all and we have to deliver the bad news. But i would agree that moms are usually relieved that it was nothing they did wrong... Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/Facebook: www.facebook.com/thesecond9months--- On Sat, 4/2/11, popikins

wrote:Subject: Re: BF after augmentationTo: Date: Saturday, April 2, 2011, 7:14 PM

If you look at the Breastfeeding Atlas you can see some photographs of women who have the appearance of insufficient glandular tissue and have both normal and abnormal lactation outcomes.

There is a difference between developed small breasts and underdeveloped breasts with IGT. I worked with a woman once who was on her 3rd baby and described classic low supply from IGT, when I examined her breasts she clearly had underdeveloped breasts, like the photo seen in the Atlas. She said she had been told "...women with small breasts can make plenty of milk", which I completely agree with, but she did not have small breasts, she had completely underdeveloped breasts with no LactII. The first question I ask is appearance of preaugmented breasts, which you've established. Sounds like she may have been correcting a pre-existing condition that may or may not be IGT. I would also ask her about the technique used for the procedure, where are the incisions for the placement which may play a role in her future outcome. Lact I is usually normal for this group, it's just Lact II that they may struggle with. I don't find midwives and physicians very

accurate with their prenatal assessments. I can't tell you how many times I've seen women with classic hypoplasia or underdeveloped breasts and check their H & P and see the prenatal breast assessment identified as normal.

I had a midwife very angry with me because I had discussed this with one of her patients who was on her 2nd baby, and had classic hypoplastic breasts, previous child, low supply, no Lact II, excessive weight loss, jaundice, no milk with added pumping etc. She chastised me that her patient's breasts were 'perfect and normal'! Well, I don't use language that is disempowering so I wouldn't tell a woman her breasts are 'abnormal' however I did compassionately discuss this possible condition with her client, who was actually relieved that her breastfeeding struggles were in fact not due to her mismanagement of breastfeeding most likely the result of an authentic physiologic condition (she did have follow up and again no Lact II)... I went and got my Atlas and showed it to the midwife , she humbly confessed she had no idea about the photos of hypoplasia, I gave her my old edition for her office.

If her breasts were developed yet simply small and the incision is not in a place of interference she should have a decent outcome. It is that wait and see though, let us know how it turns out!

>

> I'm working with my first augmentation client, which seems hard to believe. I'm actually working with her as her doula, but she mentioned to me that her midwife isn't sure if she can breastfeed, but that her doctor assured her she should be able to. She's 8 months pg now and had the augmentation maybe a year ago or so? She wants to breastfeed. She mentioned that her breast size was smaller than an A before and I wonder about insufficient ducts to start. Her MW told her that she didn't think she had "enough milk ducts" to breastfeed, so I've asked her at our next appt if there's any way I can see her pre-op photos to see if I can get an idea of what they looked like before since it's impossible to tell now. She said they weren't asymmetrical, but we'll see. What else should I be looking for with photos? Anyone know? I know this may be a "we'll see" situation and I may not be able to tell just by looking at photos, but I know the photos from our

lactation texts. I do provide lactation services as part of the doula package, so I will be working with her beyond birth to see breastfeeding to a good start, as I usually do with my clients.

>

> Thanks in advance for any thoughts you may have about this.

>

> , IBCLC, RLC, Labor Doula

> Mother Nature Birth & Lactation

> http://www.mothernaturelactation.com

> Connect on Facebook: http://www.facebook.com/theerinmoore

>

[Guest guest]

,

If this is her first pregnancy, the pre-op photos may not be of much use. A lot of women don't look like they will make much milk before they get pregnant, but the hormones of pregnancy develop ductwork nicely. On the other hand, you certainly can't guarantee her she will have plenty of milk. But you need to pursue all usual interventions for low milk supply because even some breasts that are wide-spaced still make plenty of milk, so you just can't tell by looks alone.

Two things: get her hand-expressing now. This will help to develop the ductwork and aid in establishing a better milk supply when the colostrum changes to mature milk.

Make sure she empties her breasts very frequently in the early days. Women who have had augmentation surgery are more prone to engorgement because the implants are taking up space in the breast and the milk doesn't have as much space within the breast skin. If she gets too tight, she will be signalling her body that she doesn't want so much milk and the supply will drop.

Dee Kassing

Subject: BF after augmentationTo: "" < >Date: Saturday, April 2, 2011, 7:40 PM

I'm working with my first augmentation client, which seems hard to believe. I'm actually working with her as her doula, but she mentioned to me that her midwife isn't sure if she can breastfeed, but that her doctor assured her she should be able to. She's 8 months pg now and had the augmentation maybe a year ago or so? She wants to breastfeed. She mentioned that her breast size was smaller than an A before and I wonder about insufficient ducts to start. Her MW told her that she didn't think she had "enough milk ducts" to breastfeed, so I've asked her at our next appt if there's any way I can see her pre-op photos to see if I can get an idea of what they looked like before since it's impossible to tell now. She said they weren't asymmetrical, but we'll see. What else should I be looking for with photos? Anyone know? I know this may be a "we'll see" situation and I may not be able to tell just by looking at photos, but I know the photos from our

lactation texts. I do provide lactation services as part of the doula package, so I will be working with her beyond birth to see breastfeeding to a good start, as I usually do with my clients.Thanks in advance for any thoughts you may have about this. , IBCLC, RLC, Labor DoulaMother Nature Birth & Lactationhttp://www.mothernaturelactation.comConnect on Facebook: http://www.facebook.com/theerinmoore

[Guest guest]

I appreciate everyone's time and assistance with this. I did tell her it's a matter of wait and see ultimately, but requested to see the photos just to see if there was anything "obvious" that would stand out to me. Her plastic surgeon has assured her that it shouldn't be an issue and her main concern is that the midwife is telling her she doesn't think she has much duct going on in there--no u/s or anything, just that she thinks that by looking...perhaps she made that assumption based on mother's original size. Of course we did talk about how far back ducts can go, the fact that many mothers can nurse after augmentation, etc. I did warn her of possible engorgement and part of our birth plan that isn't much of an issue with a lot of my clients IS going to be how to battle engorgement because of the crowding.We will talk about hand expressing at the visit today. We don't have much time at this point.Thanks so much, I'll keep you posted! Every new situation is fascinating AND scary at the same time! , IBCLC, RLC, Labor DoulaMother Nature Birth & Lactationhttp://www.mothernaturelactation.comConnect on Facebook: http://www.facebook.com/theerinmooreOn Apr 2, 2011, at 11:59 PM, Dee Kassing wrote:

,

If this is her first pregnancy, the pre-op photos may not be of much use. A lot of women don't look like they will make much milk before they get pregnant, but the hormones of pregnancy develop ductwork nicely. On the other hand, you certainly can't guarantee her she will have plenty of milk. But you need to pursue all usual interventions for low milk supply because even some breasts that are wide-spaced still make plenty of milk, so you just can't tell by looks alone.

Two things: get her hand-expressing now. This will help to develop the ductwork and aid in establishing a better milk supply when the colostrum changes to mature milk.

Make sure she empties her breasts very frequently in the early days. Women who have had augmentation surgery are more prone to engorgement because the implants are taking up space in the breast and the milk doesn't have as much space within the breast skin. If she gets too tight, she will be signalling her body that she doesn't want so much milk and the supply will drop.

Dee Kassing

Subject: BF after augmentationTo: "" < >Date: Saturday, April 2, 2011, 7:40 PM

I'm working with my first augmentation client, which seems hard to believe. I'm actually working with her as her doula, but she mentioned to me that her midwife isn't sure if she can breastfeed, but that her doctor assured her she should be able to. She's 8 months pg now and had the augmentation maybe a year ago or so? She wants to breastfeed. She mentioned that her breast size was smaller than an A before and I wonder about insufficient ducts to start. Her MW told her that she didn't think she had "enough milk ducts" to breastfeed, so I've asked her at our next appt if there's any way I can see her pre-op photos to see if I can get an idea of what they looked like before since it's impossible to tell now. She said they weren't asymmetrical, but we'll see. What else should I be looking for with photos? Anyone know? I know this may be a "we'll see" situation and I may not be able to tell just by looking at photos, but I know the photos from our

lactation texts. I do provide lactation services as part of the doula package, so I will be working with her beyond birth to see breastfeeding to a good start, as I usually do with my clients.Thanks in advance for any thoughts you may have about this. , IBCLC, RLC, Labor DoulaMother Nature Birth & Lactationhttp://www.mothernaturelactation.comConnect on Facebook: http://www.facebook.com/theerinmoore