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Reviews of the BFAR Book

From "The Journal of Human Lactation," the official journal of the International Lactation Consultant Association (ILCA), Volume 18, Number 2, May 2002, page 183. Reviewed by Heather Chase, MS, IBCLC.

In Defining Your Own Success: Breastfeeding After Breast Reduction Surgery, Diana West defines breastfeeding as much more than human milk and infant nutrition. She understands the broad benefits for the mother and child and their breastfeeding relationship. The audience for this important work is women who have had breast reductions and desire to breastfeed or are breastfeeding. It is written for women contemplating breast reduction surgery prior to the completion of their childbearing years, and yet it is an excellent resource for health care professionals, in particular lactation consultants.

This book is divided into 4 sections with 14 chapters. In Part 1, Before Birth: Contemplating Breastfeeding After Breast Reduction Surgery, 5 chapters describe the anatomy of the breast and types of surgery common in breast reduciton procedures. Why women choose to have this surgery, both physical and psychological, are discussed. Part II, Baby is Born: Maximizing Your Milk Supply and Developing Your Breastfeeding Relationship, contains a chapter that covers supplementing in a "guilt-free" manner. The very important Part III: Beyond Breastfeeding After Reduction: Evolving Your Breastfeeding Relationship, discusses the array of emotions and feelings a woman may experience after breastfeeding after reduction (BFAR). The only chapter of Part IV, The Professional Perspective, discusses the ways in which health care professionals can assis the mother who is breastfeeding after reduction. An appendix with a wealth of resources concludes the book.

West does a remarkable job of presenting complex scientific information in a straightforward, accurate, and easily understood terms. Without giving unrealistic expectations with regard to milk supply, she gives value to the process of breastfeeding itself. Between each chapter are individual stories written by BFAR women, with varied degrees of "success." These experiences demonstrate that it is up to the mother to define her own breastfeeding success.

Practical addvice is plentiful. Among others, West provides great tips for monitoring input and output in the early postpartum period. She gives advice on how to choose health care providers who will initiate support for the BFAR woman prior to delivery.

I have seized the opportunity to recommend this book to each and every BFAR woman in my consultation practice.

From " New Beginnings," the bi-monthly magazine of La Leche League International, Vol. 18 No. 6, November-December 2001, p. 222. Reviewed by Unity Dienes.

Until now, women seeking to learn more about breastfeeding after breast reduction surgery ("BFAR") have had few resources and no comprehensive guide to the experience. Diana West's Defining Your Own Success: Breastfeeding After Reduction Surgery is a groundbreaking new book from La Leche League International that fills this need with cutting-edge data, first-hand experience, and an upbeat, empathetic attitude.

For mothers who have had reduction surgery, this book is absolutely essential, and the questions confronting them are carefully and sensitively addressed. Will I ever be able to produce enough milk? Can I do anything to increase the amount of milk I do produce? How do I know if I need to supplement, and how do I do that without jeopardizing breastfeeding? How will common breastfeeding problems that I may face be affected by my past surgery? Most importantly, how do I achieve a successful, happy breastfeeding relationship in spite of sometimes overwhelming technical difficulties?

West does not provide pat answers to such complex questions. Instead, she provides information derived from the latest scientific research on BFAR, from the collective experiences of many BFAR women who have faced these problems, and from an impressive understanding of general breastfeeding dynamics. Some issues facing BFAR mothers, while not unique to their situation, may nonethless be exacerbated by their prior surgery. As a result, Defining Your Own Success covers many of the same topics of a more standard breastfeeding book, but is packed with the subtle ways in which breastfeeding is experienced differently by women who have undergone breast reduction. It is never assumed, however, that there is a single BFAR experience, a point which is made clear by the personal stories of thirteen BFAR mothers presented between the chapters. West strongly encourages women to develop their own support network (either on-line or in person) of BFAR mothers to combat the all-too-common feeling of facing the difficulties of BFAR alone.

The author's warmth and positive attitude provide a foundation of that support network, even when the technical information she presents is occasionally discouraging. Never judgmental, West gives many possible solutions to problems and encourages mothers to make choices that will work best in their particular situation, even if they are sometimes not ideal. After all, she reminds readers that any baby who suckles at the breast is a breastfed baby, regardless of actual milk intake, and she maintains that the only factors necessary to breastfeed are at least one breast and nipple, information, and support. If mothers provide the breast and the nipple, West will provide the information and support they need to get started and keep going.

This is a peerless resource for mothers wanting to breastfeed after reduction surgery, yet in many ways, this book transcends its unique context. For example, breast milk is honored as a priceless treasure, in any quantity a baby may receive. This perspective is paramount for any breastfeeding mother, since many women for many reasons face an uphill battle and lots of discouragement in their efforts to breastfeed. One chapter contains cutting-edge information on the unique qualities of breast milk, including detailed tables and charts of its immunological and nutritional components. In keeping with the upbeat tone of the book, however, artificial baby milk is not disparaged but is respected as adequate infant nutrition if full breastfeeding is not possible. This approach is both inspiring of Herculean efforts to breastfeed and forgiving of compromises mothers
may need to make.

Also inspiring are the descriptions of the almost miraculous functioning of the breast. It can be so hard for mothers to trust their bodies to provide for their infants, and so easy to suspect oneself unable to produce enough milk. For women breastfeeding after reduction, this very real concern necessitates extra record-keeping and more detailed knowledge about the signs of healthy infant growth. All of this is covered in extensive detail in this book, of course, and will be essential to mothers in this situation. But both BFAR mothers and women without a surgical history may be impressed by the well illustrated and simply explained discussions of both normal breast functioning and post-surgical lactation experiences. The ability of the breast to "recanalize" (to reconnect severed milk ducts) and to "reinnervate" (to grow new nerves) is amazing and may help all women have more faith and confidence in the ability of their breasts to function as intended.

The primary audience of this book is clearly comprised of pregnant or
breastfeeding women who have had breast reduction surgery and the professionals or volunteers who help them, like their doctors, nurses, lactation consultants, or La Leche League Leaders. But many others would benefit from a more casual reading, and would be impressed both by its clearly explained technical information and by its personal stories of triumph over adversity. As the author powerfully concludes, ``Each BFAR mother is a heroine...Your exceptional efforts and deep devotion to your child add a new dimension to the definition of motherhood and inspire mothers everywhere to reach greater heights of nurturing'' (271). Like a BFAR mother, this book, too, has the power to inspire mothers of any breastfeeding background with its transcendant example of a passionate devotion to children and the wisdom earned through struggle.

From "Reviewer's Bookwatch," October 12, 2001. Reviewed by James A. Cox.

"Defining Your Own Success: Breastfeeding After Breast Reduction Surgery is specifically written to enable mothers who have had breast reduction surgery to breastfeed their babies. Though breastfeeding after such surgery is generally thought impossible, recent advances in reduction surgery techniques now allow lactation capabilities to be better retained than in the past. Trial and error experience combined with knowledge has allowed thousands of post-surgical women to breastfeed in spite of the obstacles. Defining Your Success explicitly describes how to maximize a woman's milk supply and confront challenges. A special section is also devoted specifically to the professional perspective, from health care providers to plastic surgeons and maternity nurses. Personal anecdotes and several appendices round out this well thought-out reference. Highly recommended."

Reviewed by Cheryle Hopson, May 1, 2002.

14 years ago I gave birth to my son. I knew I was going to breastfeed him. He slept through the night at two weeks on. Having no breastfeeding support, no one ever told me that I should wake my son for feedings. Those few feedings during the day were not enough for him, but I was a first time mom and knew no different. At three months he was failure to thrive and I put him on bottles and formula and never looked back.

After trying for years to have more children, my husband and I gave up by the time our son went into first grade. Shortly thereafter I had my breast reduction surgery.

Five years later I gave birth to our daughter. I wanted to breastfed her also, but was told it wasn't possible since I had the breast reduction surgery. I struggled along for a few months but was using just as many bottles as any other bottle feeding Mom would. When she was three months old, I found the BFAR website, but trying to build up an already low supply was not happening for me. I gave up when she was five months old.

Then almost two years ago I became pregnant with our final child, a daughter. I was determined to breastfeed this child and started setting up my support system before she was even born. I ordered the book (which became almost like my daily Bible to me).

Loads of information guided me step by step on any possible obsticles I might encounter and possible solutions. I met with the lactation consultant at the hospital where I would be delivering and started attending LLL meetings.

My daughter made her entrance on February 26, 2001. My breastfeeding got off to a GREAT start. Because of the book I had already ordered a Lact-Aid, purchased domperidone, fenugreek, Mother's Milk Tea, and had the doctor put me on Reglan at the hospital when I delivered. I was able to exclusively breastfeed for the first three months of Savana's life.

I had a lot of obstacles along the way, but always went back to my book for the answers or suggestions. The book also dealt with many obstacles that nursing moms run into whether they have had breast reduction surgery or not. Each obsticle I was able to overcome and continue with my breastfeeding. At eight months, Savana started nursing the Lact-Aid tubing and biting as her teeth came in. I then switched over to bottles and formula. Shortly after that, Savana was diagnosed with having Cerebral Palsey - which brings many nursing challenges in itself. That is when I knew I was a breastfeeding SUCCESS!!! I had nursed my baby successfully for the first eight months of her life.

The book was a GOD send to me and carried me through all those uncertain times that I began to doubt myself and my abilities to nurse my baby. I have since donated my book to LLL and it has already been checked out twice I have been told. It makes me feel good to know that by donating this book I might help even one woman out there be as great of a success and I was.

I want to thank you personally, Diana, for all you do and the wonderful book that made breastfeeding possible for me.

Natural Family Online: What We’re Reading
Reviewed by Denise Altman, RN, IBCLC, LCCE

Nursing knowledge
Breastfeeding after a breast reduction presents multiple challenges not only for mothers but also those helping them. Many caregivers have not had any education regarding mother support; consequently, many BFAR mothers quit before having a chance to succeed. Defining Your Own Success: Breastfeeding after Breast Reduction Surgery by Diana West is an excellent resource for both mothers and breastfeeding advocates. A full one-quarter of the book is devoted to the surgical techniques and potential outcomes, with very clear illustrations. The remainder is a step-by-step guide to nursing after a reduction, including benefits, preparation, mechanics, milk supply, current research, infant development and so on. There is a section devoted to professionals and appendices with additional resources. Throughout the book are personal stories from BFAR mothers demonstrating a broad range of experiences.

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