Breast Feeding After Breast Surgery - PowerPoint Presentation

Slide1

Breast Feeding After Breast Surgery

Alganesh Kifle BSN IBCLC

NICU Lactation Coordinator Slide2

Breast Surgery Likely to Cause Breastfeeding Problems

According

to the

Institute

of

Medicine

(National Center for Health

R

esearch).

“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. Slide3

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 achievedSlide4

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 feedingSlide5

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

)Slide6

Breast Augmentation Technique

Peri areolar technique

Infra sub mammary

An axillary incision

A

n incision made around the nipple and areola. Although there is no visible scar there is often loss of nipple sensation

An incision under the breast for implant placement. Disadvantage is that the scar is visible and easily irritated by a bra

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 Slide7

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.Slide8

Techniques of Breast Reduction Slide9

VIDEO Slide10

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.

R

egeneration of such nerves would be a key component of increased lactation capacity Slide11

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

Slide12

Lactation Management for BFAR and

Augmentations

Early prenatal lactation information

R

eferral to a Lactation consultant upon admission

Assisting mother during

F

irst 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 applicableSlide13

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

I

nhibitor of

Lactation due to delayed

Lactogenesis IIMaintain 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 imperativeSlide14

THANK YOUSlide15
Slide16
Slide17

notesSlide18

.

noteSlide19

Breast Feeding After Reduction (BFAR)

Augmentation

Slide20

noteSlide21
Slide22

noteSlide23

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 experienceSlide24
Slide25