The Influence of Breast Surgery, Breast Appearance, and Pregnancy‐Induced Breast Changes on lactation Sufficiency as Measured by Infant Weight Gain

Abstract

We conducted a prospective study of the associations between several biologic and surgical breast factors and the onset of lactation in 319 healthy, motivated, primiparous women who were breastfeeding term, healthy, appropriate for gestational age or large for gestational age infants. During the last trimester of pregnancy subjects' breasts were examined for surgical incisions, size, symmetry, and nipple protuberance, and women estimated their prenatal breast enlargement. At two visits in the first two weeks postpartum, infants were weighted naked, and mothers reported the magnitude of postpartum breast engorgement when their milk came in. Breastfeeding was evaluated at each visit, and interventions were recommended for problems, with emphasis on maximizing milk yield. Lactation was deemed sufficient when an exclusively breastfed infant achieved an average weight gain of 28.5 g or more per day between the two visits. Infants gaining less than 28.5 g per day with breast milk exclusively, and those requiring formula supplement returned for a third visit at or before 21 days of age, when final lactation outcome was assessed based on weight gain between the second and third visits. Within three weeks postpartum 85 percent of the mothers achieved sufficient lactation, whereas 15 percent had persistent milk insufficiency despite intensive intervention. Of the study population, 6.9 percent had undergone previous breast surgery. Women with periareolar breast incisions were nearly 5 times more likely to have lactation insufficiency than were those without surgery (relative risk [RR] = 4.55; 95 percent confidence interval [CI] = 2.21-9.43; P less than 0.001). Insufficient lactation was significantly associated with minimal prenatal breast enlargement (P less than 0.02) and minimal postpartum breast engorgement when milk came in (P less than 0.001). Although not statistically significant, women with inverted nipples were more likely to have lactation insufficiency compared with those with normal nipples (RR = 2.94; 95% CI 1.05-8.20; P = .07). The findings from this study indicate that certain biologic and surgical breast variables are associated with lactation insufficiency.

Breast Growth and the Urinary Excretion of Lactose During Human Pregnancy and Early Lactation: Endocrine Relationships

“…According to this criterion, four of the subjects in the current study had minimal breast enlargement, yet the lowest infant growth rate was 25·7 g day¢ during the first month. However, our data are compatible with that of Neifert et al (1990), since they found that 75% of the women who had minimal breast increase during pregnancy did have a lactation outcome described as…”

Prevalence and Risk Factors for Early, Undesired Weaning Attributed to Lactation Dysfunction

“…Neifert et al followed 319 primiparous women who were motivated to breastfeed. 31 When women with prior breast surgery were excluded, 13.1% had insufficient milk production. In a secondary analysis of participants in Project Viva, 32 67 of 495 mothers (13.5%) reported early introduction of formula or weaning at less than 3 months due to problems with milk production.…”

Padrão de aleitamento materno no primeiro mês de vida em mulheres submetidas a cirurgia de redução de mamas e implantes

“…10 In augmentation surgery, although some studies assert that it does not interfere with lactation, 11,12 others mention insufficient lactation and low milk production, closely related to the periareolar incision and to the compression of the glandular tissue, as a result of the implanted volume and of the placement of the prosthesis under the gland. 9,[13][14][15] Its impact is weaker than that of the breast reduction surgery because the damage to the glandular structure is smaller or nonexistent.…”