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I had breast reduction surgery five years ago and at the time I considered the following 'pros and cons' for undergoing the surgery. Pros: (a) to relieve the physical discomfort, although I would hesitate to describe it as 'intense pain'; (b) to stop being defined by my breasts; and (c) to be able to wear 'normal' clothes like everyone else!

The 'cons' for me were: (a) the inherent danger of any surgery especially one done under general anaesthetic; (b) the risk of not being able to breastfeed; and (c) the fear that the surgery might not be a success ending in permanent disfigurement.

When I raised my concerns about breastfeeding to the plastic surgeon, she explained that yes the surgery does pose a risk to breastfeeding, but that there was not enough research to be able to quantify the risk. She put it to me that since many large breasted women have trouble breastfeeding anyway, my overall chances of breastfeeding success would not be significantly altered by the surgery. (Diana's Note: In fact, there IS a great deal of research about outcomes of women who breastfeed after breast reduction surgery. It is clearly shown by these studies to dramatically decrease lactation function. Furthermore, women with large breasts do NOT have more trouble breastfeeding than other women.)

When we finally decided to start a family earlier this year (2003) and I fell pregnant I started to research BFAR in more detail. I was dismayed by the results of one study undertaken in South America, in which only a tiny proportion of BFAR mothers were able to exclusively breastfeed for 4 months. I also learned that when breast reduction surgeons refer to a 50-50 chance of being able to breastfeed, they really mean being able to lactate, which does not mean being able to breastfeed exclusively.

As my due date drew nearer I spoke to a variety of midwives and lactation consultants about possible strategies for breastfeeding. The predominant advice was to be optimistic and to 'play it by ear'. I got the impression that there wasn't much common knowledge about BFAR issues.

When my baby was born (3 weeks ago) I put him to the breast as soon as I could after the emergency caesarean. I knew I could produce colostrum because I had been able to express a few drops prior to the birth. The first couple of days were very difficult. I had a big, hungry baby boy who would suck and suck but obviously wasn't getting enough to drink. He spent almost all day crying with hunger and soon developed red blisters on his chin and around his mouth from all the futile sucking. The baby was passing urates and not urinating frequently enough. The midwives could see I was starting to panic and they became very attentive and helpful. By day 4 he had lost more than 10% of his body weight. Prior to the birth I had planned to continue exclusive breastfeeding for at least 2 weeks, to see whether the baby continued to lose weight, however I was unprepared for the emotional and physical reality of a hungry, thirsty, crying baby and went straight to supplementing with formula at the advice of the paediatrician.

Although I know that at least I was able to give my baby some colostrum and milk in the early weeks, I have had to deal with feelings of failure and guilt at 'giving up' on breastfeeding so early. I also felt that the fact that my son is so 'collicky' and unsettled all the time could have been due to not breastfeeding. If I had known then what I know now, perhaps I would have waited for the reduction surgery, but then again, perhaps more knowledge would not have helped. Unless you're a mother, you can't truly appreciate the powerful and overwhelming urge to feed your baby and the feelings that go along with not feeling that you can't give him or her the very best. In hindsight, perhaps I should have sought counselling before making the decision to go ahead with the surgery. Maybe GPs need to consider this before referring women to plastic surgeons.

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