Have you had breast reduction or augmentation surgery?

If you’ve had previous breast surgery, make sure you understand how to eliminate nipple and breast tissue drag and how to offer the breast frequently and flexibly, then give breastfeeding your best go! You and your breastfeeding support professional can monitor the baby’s throughput and weight gain together to work out when or whether you need to be supplementing with commercial milk formula or donor milk. Breastfeeding is so much more than the transfer of milk! Even if your breast milk production doesn't meet your baby's needs for calories, you might enjoy offering the breast frequently and flexibly simply because it is a useful tool for dialing your baby down – and a wonderful way to share closeness and affection.

Breast augmentation and lactation

You may be one of the many women who've had breast augmentation - it's one of the most commonly performed plastic surgeries around the world. Mostly the women I see in the clinic who've had implants breastfeed successfully, and meet all their infant's caloric needs.

A 2026 systematic review found that incisions around the areolas were more likely to impact on breastfeeding than incisions at the base of the breast, but that overall breast implants don't have a big impact on breastfeeding rates. This is reassuring news!

Breast reduction surgery and lactation

If you've been a woman with very generous breasts, you may have found that reduction surgery significantly improved the quality of your life. Almost half a million breast reduction surgeries are performed around the world each year. Removing the weight of breast tissue has been shown to relieve shoulder, back and neck pain, reduce headaches, make exercising more comfortable, and as a result of all of this, breast reduction surgery can substantially improve a woman's mental health and wellbeing.

Breast reduction techniques are performed along a spectrum of approaches. The column of breast tissue which runs towards the chest wall from under the areola is known by surgeons as the column of subareolar parenchyma.

• If you’ve had a breast reduction, and the surgeon left the column of subareolar parenchyma intact, there is reason to hope you’ll be able to produce milk for your baby for as long as you want, although perhaps you won't be able to do this exclusively in the first months.

• But if your nipple has been completely shifted during a reduction, which severs the milk ducts, your breast is unlikely to make much milk.

If you’ve had breast reduction surgery, it’s useful to know what kind of surgery you had, so you can be realistic about how the glandular tissue in your breast has been affected. Let's look at this in greater detail.

If a large column of your glandular and duct tissue was preserved

Since the research in 2017 which showed how certain kinds of breast reduction could seriously disrupt breastfeeding, many plastic surgeons have been more careful to discuss technique options with women, aiming to preserve the entire column of subareolar parenchyma in women who may yet want to breastfeed. This is called the ‘pedicle technique’.

This approach has been shown to have the best breastfeeding outcomes, with exclusive breastfeeding possible for some or even many women post-reduction surgery, because most of the alveolar glands and milk ducts lie under an area of about three centrimetre diameter beneath the nipple.

If the subareolar column was fully preserved in this way, it's realistic to aim for exclusive breastfeeding. Even though it’s unclear to what extent the reduction will impact on your capacity to exclusively breastfeed your baby, there’s every reason to go forward as if you can - at the same time as your health professionals carefully monitor your baby's weight gains.

In order to develop the best possible breastfeeding experience with your baby, it’s important to eliminate breast tissue drag as best you can, and to offer the breast frequently and flexibly.

If your nipple was transplanted

At one end of the spectrum of breast reduction surgery, the plastic surgeon completely removes and transplants the nipple. Unfortunately, this technique severely disrupts future breastfeeding because all of the lactiferous ducts in the column of subareolar parenchyma are severed.

If you had a complete nipple transplant, and milk transfer is unlikely to occur, you might still enjoy offering the baby the breast to dial him or her down and to enjoy the closeness of having baby at your breast, anyway, just whenever you want to.

If you've had partial preservation of a column of your glandular and duct tissue

Other women receive surgery somewhere in between on the spectrum, with partial preservation of the column of subareolar parenchyma. Many of these women are able to breastfed until at least six months, either exclusively or partially.

If there was partial preservation of the column of breast tissue, I propose that you aim for exclusive breastfeeding, anyway, but have your health professional monitor you and the baby carefully. New glandular tissue is likely to be created during pregnancy, and if you offer frequent flexible feeds with positional stability, your baby will help create the supply he or she needs from the glandular tissue that is still there behind your intact ducts. Your breast may prove to be remarkably resilient.

If you no longer have sensation in your nipple and areola

Some women who’ve had breast reduction surgery report that they don’t have sensation of the nipple and areolar. The nerve supply is commonly disrupted in any breast reduction surgery - but this loss of sensation doesn't seem to interfere with breastfeeding. Remember, too, that nerves can slowly regrow, and nipple sensation returns for many women post-surgery. If there is loss of nipple and areolar sensation, you need to pay particular attention to the elimination of breast tissue drag, so that the nipple is not injured in the absence of the feedback of sensation.

Selected references

Geddes DB. The anatomy of the lactating breast: latest research and clinical implications. Infant. 2007;3(2):59-61.

Geczi AM, Pal P, Varga T. Impact of breast augmentation, reduction, and nipple repair on breastfeeding success: a systematic review and meta-analysis. Aesthet Surgery Journal 2026:doi:10.1093/asj/sjag1117ery.

Kraut RY, Brown E, Korownyk C, Katz LS. The impact of breast reduction surgery on breastfeeding: systematic review of observational studies. Plos One. 2017;12(10):e0186591.