Breastfeeding after treatment

Women who become pregnant after completing breast cancer treatment often assume they won’t be able to breastfeed. Though that’s true for some women, others will be able to breastfeed.

Breastfeeding after treatment is safe for you and your baby as long as you are not on chemotherapy or taking long-term medicines such as tamoxifen, an aromatase inhibitor or trastuzumab.

Ask your doctor how long you must wait after your chemotherapy ends before it is safe to breastfeed.

You should not breastfeed while taking these medicines. If your treatment plan includes long-term treatments like tamoxifen, aromatase inhibitors or trastuzumab, talk with your doctor about:

• when you can stop taking them to be able to breastfeed
• how long you should wait before starting to breastfeed
• when you should start taking the medicine again.

Feeding your baby milk from your breast or breasts gives him or her important nutrients and boosts their body’s ability to fight illness. After breast cancer, some women also find that breastfeeding helps them regain good feelings about their bodies.

Research shows that women who breastfeed for 6 months or more before being diagnosed with breast cancer have a lower risk of recurrence than women who do not breastfeed. It is unknown whether this is also true for women who breastfeed after treatment.

If you are unable to breastfeed, or choose not to, that’s okay. Breastfeeding can be difficult, even for women who have not been treated for breast cancer. You can still give your baby physical closeness and love while bottle feeding. Caring for your baby is about what’s in your heart, not your breasts.

If you became pregnant during treatment, were diagnosed during pregnancy or have metastatic disease, talk with your oncologist about how your treatment needs affect pregnancy, breastfeeding and safety for you and your baby.

Breastfeeding after surgery & radiation

Surgery may remove milk ducts and other breast tissue. Radiation therapy may damage them.

Mastectomy removes the entire breast, so women who have a single mastectomy can only breastfeed from the remaining breast. Women who have double mastectomies will not be able to breastfeed because both breasts are removed.

It’s often possible to breastfeed after lumpectomy. But, radiation, often given after lumpectomy, may reduce or stop milk flow in the breast that was treated. Even if one breast stops producing milk, babies can be fed by nursing on the other breast.

Breastfeeding after lumpectomy

Lumpectomy removes the tumor and a margin, or rim of healthy breast tissue, around it. In many cases, breastfeeding from a breast that has had lumpectomy can work.

“The breast is a pretty remarkable organ,” says Barbara Wilson-Clay, BS, IBCLC, FILCA, a board-certified lactation, or breastfeeding, consultant. She explains that a breast has lobes much like orange sections. The lobes, which function independently of each other, contain lobules, glands that produce milk.

When lobes are damaged by lumpectomy or biopsy, the lobules within them might fill with milk at first, but dry up over time. The lobules in undamaged lobes in that breast will still produce milk.

Breastfeeding after radiation

Radiation may damage lobules. It can stop them from making milk entirely or change the appearance of breast milk. After radiation, breast milk may look thicker and darker.

While there’s no evidence feeding babies this milk is dangerous, some women choose to not feed from the breast treated with radiation.

Breastfeeding from one breast

Breastfeeding usually involves feeding from both breasts. Alternating breasts each time you feed your baby helps your body maintain a good milk supply and helps you avoid nipple irritation. Still, it is possible to feed a baby with only one breast. One breast can even feed two babies by using a little creative management.

When feeding from only one breast, the nipple on the feeding side may become sore from so much use. Gently rubbing a little breast milk on the nipple may relieve it. If you have to feed from your dominant hand side, it may feel awkward to hold the baby on that side. Small pillows can help, or asking someone to assist you.

Using a breast pump between feedings will help keep milk flowing from your breast. Extra milk may be frozen and later fed by bottle. If your milk supply is limited, you may need to supplement breast milk feedings with formula feedings.

Tips for breastfeeding after treatment

This advice may help as you navigate breastfeeding after breast cancer.

• Line up support before you begin to breastfeed.
• Be gentle with your breast or breasts. Sometimes women are advised to “toughen up” their nipples for breast-feeding by rubbing them with a dry towel, loofah sponge or scrubbers. This is not needed and should not be done.
• As breast lobes damaged by treatment adjust and dry up, use cold packs or take ibuprofen to ease discomfort.
• Rent or buy a high-quality breast pump. This can help you get as much milk as possible from one breast or from a breast that’s producing a low amount of milk.
• Feeding from just one breast can make that nipple sore. Gently rub a little breast milk on the nipple to help it heal.
• Because nursing bras are sized for two larger, nursing breasts, use a cup insert in your nursing bra if one breast is much smaller.

Breast milk banks & milk-sharing

You might still want to feed your baby human milk, even if you know your breasts can’t produce milk or that they don’t produce enough. It’s natural to want to give your child the benefits and nutrients that breast milk provides.

You might be interested in breast milk banks or milk-sharing networks. Through these, you can get human breast milk that is donated from another woman.

Nonprofit milk banks take donated breast milk from donors who are screened for good health through interviews, surveys and blood tests. Milk from 3 to 5 women is combined and pasteurized with high heat to kill anything that may cause disease. This processing is done under sterile conditions at the milk bank.

• Donor milk is tested to make sure it is safe, free of bacteria and has the right calories, proteins and other nutrients for your baby’s healthy growth. Milk banks will not accept milk donors who test positive for HIV, hepatitis B or C or other infectious diseases, or if they or their sexual partners are at risk for HIV. Donors also may not regularly use most medicines or herbal supplements, use illegal drugs, smoke or use tobacco. There are other restrictions as well.
• Most donated milk goes to premature, sick or high-risk infants, but babies of women who are unable to breastfeed due to breast cancer treatment have also received it.
• A physician must write a prescription for your baby in order for you to get human milk from a milk bank.
• Health insurance and Medicaid sometimes pay the fee for donated milk, which varies but runs about $4.50 per ounce. Milk banks fundraise to cover costs for some people.

The Human Milk Banking Association of North America has 20 member milk banks in the U.S. and Canada, with 9 more in development. Contact one near you to find out about their program.

Milk-sharing networks offer another route to getting human milk. These do not have the same health testing and safety processing systems as milk banks.

• Some milk sharing happens between people who know each other and live nearby, so milk can be stored and transported easily. Talk with your pediatrician or a milk bank about how to screen the donor’s health and how to handle donated milk.
• Other networks are online businesses that post ads from donors or sellers, who generally are not screened for health risks.
  • A buyer sees the ad, pays the seller and the milk is shipped.
  • The milk may be less expensive than from a milk bank.
  • There is no official safety or health control of what’s in milk bought from a donor or seller or how it has been handled.
  • Buyers can use equipment at home to try to reduce disease risk in the milk by heating it, but that is not as safe as commercial pasteurization, or heat processing, conducted by milk banks.

Support for breastfeeding after breast cancer

Finding emotional and practical support will help you with breastfeeding challenges. You may want to have a board-certified lactation consultant guide you through the first days and weeks of breastfeeding. Look for a consultant who is experienced with women who have had breast surgery or radiation, and choose someone you can meet with in person, who can examine your breast or breasts.

• Check members of the International Lactation Consultant Association, or ILCA, for a professional in your area. You can also ask your obstetrician or pediatrician for a recommendation.

Talk with your spouse or partner, close family and friends who support your breastfeeding. Having a support person nearby to help with whatever you need, especially during the first few weeks of breastfeeding, can be strengthening.