Is one breast enough? Understanding breastfeeding after mastectomy

Women with breast cancer who undergo mastectomy or removal of a breast as part of the treatment are often worried that if they have a child, they will not be able to breastfeed the baby.  This is not true, and for most women who have had a mastectomy on one side, feeding a baby from the remaining breast is very much possible.

The reason is how the breasts function; each breast works independently of the other. Prolactin, the hormone that causes the breasts to produce milk, reaches both sides through the bloodstream, but the signal to make more milk is local. This means that if a baby is fed more from one breast, then that breast is emptied frequently and produces more milk. On the other hand, a breast that is not fed from gradually stops making milk. A single breast produces enough milk for a single baby well within the body's normal range.

What women are wrongly told

Some women think that something of the cancer or cancer cells will reach the baby through the milk. But breast cancer is not an infection and cannot be passed on through milk. Neither does feeding increase the chance of the disease returning. In fact, studies have shown that breastfeeding is associated with a modest reduction in risk of a woman getting breast cancer.

In case a woman is undergoing cancer treatment, then caution must be exercised. Chemotherapy drugs are transferred to breast milk, so feeding during chemotherapy is not safe. Tamoxifen and other hormone treatments are also incompatible with feeding and suppress production of milk.

The effect of radiation therapy depends on the type of radiation. Standard external beam treatment leaves neither the woman nor her milk radioactive. But as it causes scarring in the ducts, an irradiated breast will usually yield little milk. However, the untreated side will produce milk normally. Scans using radioactive tracers may require milk to be discarded for the period of treatment. The oncologist and paediatrician are the right people to guide in this regard.

Coming to nipple-sparing surgery, while the procedure preserves the natural appearance of the breast and some sensation, the operation removes the milk-producing tissue behind the nipple.

Whatever the technique, a breast that has had a mastectomy will almost never produce milk. This is to be considered by women with an inherited gene fault that significantly increases risk of breast cancer who may be considering preventive surgery to remove the risk. They must understand the effect of the procedure on breastfeeding in future if they plan to have a child.

Is the baby having enough milk?

This must be judged by the baby’s physical development with signs such as steady weight gain and meeting the growth milestones.

Do not let feeding delay a check-up. A lactating breast is naturally lumpy, and blocked ducts and mastitis are common and almost always harmless. However, in case of a lump that has not reduced in a fortnight, or a red patch that doesn't respond to antibiotics, a mother must undergo an ultrasound scan.

What if the milk is not enough?

Sometimes one breast may not produce enough milk for the baby’s needs, particularly if it has undergone irradiation. After surgery on both sides, feeding may not be possible at all. Mixed feeding and formula milk are then options.

Many women may feel the loss of the ability to feed as a grief quite separate from the cancer. This can happen years later after recovery when they have a baby. Counselling can be beneficial in this case.

If a woman is planning a baby after breast cancer treatment, she must speak to her doctor about feeding beforehand to understand what to expect.

The author is a consultant and breast oncology surgeon at Kokilaben Hospital, Mumbai. 

 

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.