While there are many resources online for dealing with breastfeeding initiated after surgery, it is much more difficult to find anything on healing from a lumpectomy or surgery for a breast abscess on a lactating breast. Consultation of several sources of information revealed that there are many options — good ones — for the breastfeeding mother. Armed with information, a mother in this situation can talk to her medical providers for advice and make the best decision for her.

Here is my understanding about healing after surgery on a lactating breast:

1. Continued breastfeeding can be beneficial because it helps prevent engorgement and mastitis (breast infection). By contrast, binding the breast risks complicating the healing with a breast infection.

2. If milk ducts are cut during the surgery, leaking is to be expected.

3. Breast milk has antimicrobial and healing properties that actually can help the wound heal. The leaking breast milk can help keep the area clean and avoid infections common to open wounds.

4. In the case of leaking breast milk, healing takes place from the inside out (rather than from stitches or glue sealing the wound). It helps to understand that healing takes considerably longer (weeks, not days) but that it can happen and not to worry.

5. Gauze can be used to dress the incision. Replace the gauze as needed to keep the area relatively dry (which means replacing it after every feeding, and potentially multiple times in between feedings as necessary). Try to tape the dressing on consistently so that the sides and edges of the wound stay in the same proximity.

6. Consider whether a low-dose prophylactic antibiotic would be helpful. Factors might depend on worry over infection, the mother’s tolerance for antibiotics, and the mother’s tendency to develop thrush (a yeast infection). If the mother does take antibiotics, she should consider taking probiotics/acidophilus/eating yogurt with live cultures to replenish the good bacteria that can keep her from developing thrush.

7. The mother could cut back to nursing just a few times a day on the affected side (say, morning, noon, and before bed) and that will cut back on the milk flow. It would still be necessary to dress the leaking wound with gauze. Once the wound heals, the mother could try to nurse fully again on that side, keeping in mind that it will take a while for the supply to build back up.

8. One-sided nursing is possible. The mother would need to cut back on nursing on the affected side (slowly, so that she does not develop engorgement or mastitis) and nurse considerably more often on the other side (at least twice as often in the beginning), being sure to watch the baby’s urine and stool output and weight gain, to make sure the baby is getting enough milk. Again she could try to re-lactate on that side once the wound heals. One-sided nursing can result in lopsidedness, which may or may not be bothersome. One solution is to use a mastectomy breast prosthesis when it matters.

9. Weaning completely is also an option. Again the mother would want to do so in a manner that limits her risk of breast infection.

Sources for further reading:

1. The Breastfeeding Answer Book, p. 507 on healing after surgery for a breast abscess.

2. Surgery and the Breastfeeding Mother, from Lactation Education Resources.

3. The following discussions, opinions, and personal stories on the breastfeeding professionals’ email listserv Lactnet: one, two, three, and four.

Post from: Breastfeeding 1-2-3

After breast cancer treatment, there is no evidence that breastfeeding increases the risk of breast cancer recurrence, nor that it carries any health risk to the newborn. Women previously treated for breast cancer and free of recurrence are allowed to breastfeed their children. Beneficial effects of breastfeeding for the mother and the newborn should lead physicians and midwives to encourage prolonged breastfeeding in their medical practice.

Furthermore, another review states:

A frequently named reason not to nurse is the discouragement by the health care provider. Women treated with breast cancer should be encouraged to breastfeed their children.

Yesterday I raised the question of breast cancer treatment options for women who wish to preserve their ability to breastfeed. Continuing my series for National Breast Cancer Awareness Month, today I take a look at chemotherapy, radiation, lumpectomy and mastectomy. I mention these only as a springboard for discussion with a woman’s oncologist. Naturally the feasibility and risk associated with each option depends on the particular diagnosis. As a starting point, here’s some basic information on chemotherapy, radiation, lumpectomy and mastectomy from a lactation perspective.

1. Chemotherapy. Chemotherapy requires the breastfeeding mother to wean for the duration of the chemotherapy treatments. An oncologist could advise the mother at what point it would be safe to resume breastfeeding. It is possible to test some expressed breast milk to see if all of the harmful agents have cleared from the mother’s system. Even if the course of chemotherapy was lengthy and the mother was unable to keep up her supply, it may be possible for her to re-lactate. Certainly chemotherapy preserves a woman’s ability to breastfeed subsequent children.

2. Radiation. A mother who receives radiation on one breast can continue to nurse uninterrupted on the unaffected side. Once a doctor has deemed it safe to nurse on the affected side, it remains to be seen how much milk that side will produce–some mothers experience a decrease in supply while others maintain adequate supply.

3. Lumpectomy. A nursing mother would be wise to choose a surgeon who has experience operating on a lactating breast, both because the presence of milk can complicate the surgery slightly, and an experienced surgeon can minimize the cutting of major nerves and milk ducts. Nursing can resume immediately after surgery, as soon as the mother is comfortable. Of course, if the surgery affected only one breast, nursing can continue uninterrupted on the other side. Kellymom.com offers several resources on breastfeeding after breast surgery, including lumpectomy and breast reduction.

4. Mastectomy. A mother who undergoes a single mastectomy can continue breastfeeding uninterrupted on the other side. Thanks to the principle of supply and demand, it is possible for a mother to produce enough milk to feed her baby from her remaining breast.

Post from: Breastfeeding 1-2-3