I didn’t expect to get pregnant with my second child after I’d had a breast reduction the year before. I fully believed I was going to have only one child, and that’s what I told my primary care physician, as I was having severe back problems due to what were called “large, pendulous breasts.” I had the operation, and when that didn’t completely alleviate my back pain, I had surgery in my lower lumbar region. When I discovered I was expecting again, I really didn’t worry about nursing, as I’d had no problem breastfeeding my first child and thought there wouldn’t be too much of a difference the second time around. Imagine my dismay when I had trouble nursing my daughter after giving birth.
I don’t want to seem like I was noble for wanting to nurse, but in all honesty I felt it was easier to co-sleep and feed my baby rather than get up every two hours to make a bottle. I didn’t want to do all that work when I had perfectly good breasts I could pop in her mouth and go back to sleep. The same midwife delivered both my children and encouraged me to breastfeed. One of the things we were told to look at was the amount of urine the baby produced. Too many dry diapers equaled not enough fluids. I used diapers that had smiley faces on them—if they disappeared, that meant the baby was wet. I wasn’t seeing that often enough—and worried my daughter wasn’t getting enough sustenance—so I panicked and called my midwife. This was in 1998 and Black women weren’t really encouraged to breastfeed, much less those of us who encountered difficulties. We were offered formula and sent on our way. But all was not lost.
I won’t say it was a comfortable process to have the LC watch me nurse and manipulate my breasts, but her conclusion was that my milk ducts weren’t producing enough—likely a consequence of the surgery.
The midwife advised me to go to the Women, Infants, and Children (WIC) office and speak to a lactation consultant (LC). I didn’t know of the program beforehand, but I discovered that my local center in the Bronx offered services. I won’t say it was a comfortable process to have the LC watch me nurse and manipulate my breasts, but her conclusion was that my milk ducts weren’t producing enough—likely a consequence of the surgery.
The lactation consultant heard my distress and offered a solution called the supplemental nursing system (SNS). It’s a thin, flexible tube that is taped to the mother’s breast near her nipple on one end. The other end is attached to a tubular cup, which contains additional breast milk or infant formula. The child has both tube and nipple in their mouth. The suction pulls from both breast and tube, this is done in order to cut down nipple confusion. It allows the ability to successfully nurse even with breast reduction or biopsy. With this tool, I was able to nurse my daughter well into a year without fear.
I’ve encountered many women who’d never heard of this option, which inspired me to find out why it’s not talked about more often and how to help spread the word.
I spoke with Rose St. Fleur, MD, FAAP, FABM, IBCLC, who is a fellow of the American Academy of Pediatrics and the Academy of Breastfeeding Medicine. She’s a board-certified lactation consultant and medical director of the Center for Breastfeeding, a breastfeeding medicine office that practices evidence-based care and support for mothers, infants, and families.
The SNS reduces the two-step feeding process of breastfeeding and supplementing using the bottle or spoon/syringe into a one-step process.
I asked her about her role in providing assistance for those who’ve had breast reduction, augmentation, or biopsies.
How does a breast reduction affect nursing efforts?
Most breast reductions involve resizing and/or moving the nipple and areola to a different location on the breast for a better cosmetic effect. In addition, actual breast tissue is removed from the breast during the procedure. Both of these can significantly affect both a woman’s ability to make milk, given she has less breast tissue, and the breast’s ability to respond to hormonal cues from the brain to make and release milk.
Do you teach women how to use the SNS system? Do you provide it for your clients?
At our breastfeeding medicine practice, we purchase the tool in bulk and then give out the SNS for no additional fee. This is because time is of the essence when it comes to mothers with low supply; each day of waiting to increase the supply may make it more difficult to correct. In addition, ordering and waiting for an SNS to come in the mail, or even making an additional stop to a store to buy a system, poses a barrier to care. When we provide the tool to the mother, we perform hands-on teaching on how to use and how to keep it clean. It can be very easy to use when taught correctly by a lactation consultant or other provider with expertise in breastfeeding.
Do you believe the SNS system works well? Is there a specific model you prefer?
For some mothers, the SNS works beautifully. When a mother has a low milk supply, we often recommend pumping the breasts to stimulate more milk. Then, if the baby does not get the quantity it needs, we recommend giving extra milk to the infant using a bottle or, for some newborns, a spoon/syringe. The SNS reduces the two-step feeding process of breastfeeding and supplementing using the bottle or spoon/syringe into a one-step process. There are few competing brands out there, so at our breastfeeding medicine practice, we often use the Medela brand since it is easy to find, but we do not endorse or promote any specific brand.
What kind of formula do you recommend if using the SNS?
The Academy of Breastfeeding Medicine recommends newborns who are in need of supplement with additional milk besides mothers’ own breast milk use pasteurized donor breast milk from a donor breast milk bank. Her medical provider, lactation consultant, or other provider with expertise with breastfeeding can assist in helping her access this milk. If infant formula must be used, consider a hydrolyzed protein formula in a newborn, based on medical evidence it may mitigate jaundice and risk for allergic potential.
How does WIC help with breastfeeding support?
WIC is a supplementary feeding program for financially eligible mothers and their families. Many people falsely believe that WIC only provides formula and additional foods—not true! In fact, WIC is a wonderful resource for any mother who is breastfeeding, formula feeding, or doing anything in between. WIC offers a range of services, from face-to-face professional assistance for breastfeeding mothers to online tips, in a variety of languages. Even with anticipated challenges, many women who have had breast reductions still can nurse successfully.
WIC is a wonderful resource for any mother who is breastfeeding, formula feeding, or doing anything in between.
These organizations offer information and support for those desiring a successful breastfeeding experience.
This highly regarded U.S. and international nonprofit organization gives a tremendous amount of support to Black, Brown, transgender, and non-binary nursing families.
Breastfeeding support and guidance from the program’s nutrition staff is available through Certified Lactation Counselors (CLC) and peer counselors. Ask for the free breast pumps program.
The National Breastfeeding Helpline: 1-800-994-9662
The American Academy of Pediatrics
Like this piece? Subscribe to our newsletter for real stories about women on their journey to motherhood.