I had a breast reduction done in 1992 and my first daughter in 2000, my 2nd in 2001, and now my 3rd in May (at the age of 43). Two were born at 36 weeks and the one in 2001 at 38 weeks, but with very low muscle tone. Their prematurity and muscle tone issues have contributed to breastfeeding difficulties. I was also told that hypothyroidism, infertility issues, and my age were also factors that would limit my success.
My surgery was a free nipple graft surgery with a total of 1400 grams removed. I was told I would never be able to breastfeed. I was determined if I had any possibility I would do what I could. I nursed my first for 6 weeks without assistance from pumping or medication and then had to start supplementing. At that point, I went to a lactation consultant, La Leche League, and an occupational therapist for assistance. I also pumped, used a Supplemental Nurser, and tried fenugreek. Unfortunately my daughter refused to nurse with fenugreek. I nursed her for 6 1/2 months until I had a severe throat infection and became dehydrated and my daughter rejected the SNS.
My second daughter was born at 38 weeks with low muscle tone and did not gain weight well enough to only BF and use an SNS. However, I did start on fenugreek at two weeks of age with more success. I pumped and bottlefed for about 10 days and then started with an SNS and breastfed only at night.
By the time she was two months old, she quit taking a bottle after nursing. At five months of age, we moved to another state and threw away about 2 gallons of pumped milk. After that I quit pumping, but breastfed exclusively until she was 8 1/2 months old and stopped breastfeeding altogether at the age of 2. She would not eat solid foods until then, so I had to nurse every three hours around the clock. I might also add that she was in the 75% for weight.
What helped and contributed to my success? I attribute it to doing whatever it took to get her strong enough to successfully extract all that she could and to fenugreek. Due to a few quirks, such as taking a fourth dose because I was up late and the third dose had been too early in the evening, I ended up taking four capsules four times daily instead of the reccomended three capsules three times daily. I might add that I had talked with my pediatrician and Arizona Poison Control extensively about the safety of that dosage.
I am currently on my third baby and second 36 weeker. My pregnancy was uncomplicated until the end when it was thought that there was some growth retardation. After delivery, she did not appear to be growth restricted. My blood pressure had been very low and may have contributed to her not nursing well. In any case, I pump like crazy, use an SNS, take fenugreek, and supplement with bottlefed pumped breastmilk. She is starting to get the hang of nursing (she is 3 weeks old) and expect that she, too, will be successful at breastfeeding.
Other things I have found helpful: Drinking about 500mL of warm water when I breastfeed or pump [Editor's Note: increased water intake does NOT increase milk production], taking a quick hot shower just before breastfeeding, breast massage while pumping, having my baby there in front of me while pumping (bouncy seats are great for that), and especially always going for that last drop! It does seem to be harder than the first time and it is perhaps due to age. I do know that I can be successful and hold that carrot in front of myself to keep me on track!
I really hope this helps someone else. Keep on trying, it gets better and is completely worth it.