Breast surgery may be divided into two categories:  General breast surgery and plastic surgery.

For surgery involving breast cancer, see breast cancer section. For surgery for benign conditions, such as fibroadenoma, a patient may have undergone a diagnostic core needle biopsy by radiology and subsequent surgical excisional biopsy.  There is no contraindication to breastfeeding for either of these procedures¹. Though theoretical risk of damage to nerves and/or underlying breast parenchyma is possible², it is uncommon in the setting of small incisions and low volume excisions. The most challenging situation for breastfeeding may occur in the setting of a large periareolar incision³ or complete excision of the retroareolar ducts.  However, recanalization has been demonstrated in animal models⁴. In order to understand the necessity of the procedure, we recommend discussion with surgery prior to undergoing an elective operation.

There is no contraindication to breastfeeding after plastic surgery such as breast reduction, breast lift, or augmentation.  However, glandular tissue, nerves, and/or the NAC may have been disrupted during or affected by these procedures^5,6 and careful evaluation by a breastfeeding medicine specialist is recommended.

Surgery itself is not a contraindication to breastfeeding.  However, several perioperative considerations should be addressed prior to undergoing an elective surgery, and a perioperative lactation support plan is recommended⁷. We recommend planning regarding variables such as total duration of separation of breastfeeding dyad including anticipated operative time, positioning time, and recovery room stay; plan for expression of milk in the preoperative holding area and post-operative recovery room; positioning on the operating room table to avoid unnecessary restriction/compression of lactating breasts; potential that the breast may be near the surgical field (e.g. thoracotomy); and, possibility of post-operative intensive care unit (ICU) stay with prolonged intubation.

Female to male transgender patients may undergo “top surgery” to reduce the female contour of breast parenchyma to a preferred more flat chest wall consistent with that of cis males⁸. The volume of breast parenchyma removed may vary widely among individuals, often based on BMI/body habitus and surgical technique.  Patients may or may not undergo resection of the native nipple areolar complex (NAC)⁹. If the NAC is removed, reconstruction, either surgical or via techniques such as tattooing, may occur at the index procedure or in a staged fashion.  If the NAC is not removed, post-surgical scarring may affect subsequent NAC pliability and sensation.  Nerves and/or blood vessels supplying the NAC may or may not have been interrupted, consistent with risk known to all other reduction and tissue rearrangement procedures on the breast. Due to these factors, male to female transgender patients may report variable experiences with engorgement, volume of milk produced, and challenges with latch. A full review of LGBTQI patients and lactation is available at bfmed.org with The Academy of Breastfeeding Medicine Protocol #33: LGBTQI and Breastfeeding.