Breastfeeding After Breast Cancer

By Lauren Lisle

Experts: Ashley Georgakopoulos, IBCLC; Jenelle Ferry, MD; Nicole Peluso, IBCLC

Breast cancer affects more than 11,000 women under age 40 annually in the U.S., making it the most common malignancy among women of childbearing years. For new and soon-to-be mothers who have survived cancer, welcoming a baby can be an intimidating time of questioning and feeling concerned over breastfeeding and the well-being of her and her baby’s health.

If you are expecting a baby after treatment, be encouraged that successful breastfeeding is “absolutely possible,” according to Nicole Peluso, IBCLC, lactation services lead at Aeroflow Breastpumps, a mother and breast cancer survivor who is currently nursing.

However, there are important considerations to make and potential challenges associated with breastfeeding after breast cancer that women should know about to best prepare for the postpartum period and beyond.

The Challenges of Nursing After Breast Cancer

There is a multitude of barriers when hoping to breastfeed after cancer, says Jenelle Ferry, MD, neonatologist and director of feeding, nutrition, and infant development at Pediatrix Neonatology of Florida.

“Challenges to initiating breastfeeding [after cancer] can include medical counseling against breastfeeding, lack of maternal counseling or medical support, assumption that breastfeeding is unfeasible, and maternal uncertainty. Challenges to continued breastfeeding include lack of lactation support, insufficient milk supply, and the possibility of more nipple pain and discomfort on the untreated breast,” she says.

Specific obstacles mothers may face depending on how their cancer was treated.

“After radiation, lactation is possible in about 50% of women (for the affected breast), albeit with a significant reduction in quantity,” explains Dr. Ferry, noting, “Radiation may also increase the risk of mastitis.”

Patients who required surgery may experience a range of success depending on whether or not the cancer metastasized, as well as the location of the cancer.

“A common spot for breast cancer is behind the nipple. If ducts are cut right behind the nipple, a lot of damage is done to the flow of milk,” explains Peluso. “If cancer is outside of the nipple area, severed nerves responsible for the ejection of milk from the breast can compromise the breasts’ ability to remove the milk.”

The good news? There are two breasts, meaning if the cancer was confined to one breast, you can still feed from the other side.

“As long as the breast tissue is healthy and intact, it has the capacity to still provide breast milk in the supply needed,” says Ashley Georgalopoulos, IBCLC, lactation director for Motif Medical. “Even in the case of one breast being present, it just may feel very lopsided once lactating.”

While it may be uncomfortable, it’s still manageable to feed from only one side, as Peluso illustrates in explaining how a mother nurses a set of twins, saying, “If you think about twins being able to successfully breastfeed, a mom who can only nurse from one breast is doing the same amount of work on that one breast as a mom of twins. Double milk production and double labor on the healthy breast is definitely doable and poses no risks to mom or baby.” Taking it a step further, Dr. Ferry says there have even been reports of moms feeding twin babies from only one breast—amazing!

The same rule can apply to women who have undergone a mastectomy, as long as there is enough breast tissue to sustain breast milk capacity. In fact, Georgalopoulos says even exclusive breastfeeding is possible in some cases because whether it’s from one or two breasts, the body is designed to meet an infant’s demand for more breast milk through adequate stimulation and milk removal. Unfortunately, breastfeeding is usually not successful following a double mastectomy, as the goal is to remove as much breast tissue as possible, leaving little milk-making tissue after breast surgery.

Another issue mothers face is forging a renewed mind-body connection that views the breasts as a “life-giving part of [the body] versus something that is trying to kill you,” says Peluso. To assist with this connection, she recommends all breastfeeding moms learn the important skill of manual expression, which is a method that involves gently removing milk from the breasts by hand. This practice of routine touching can help women relearn and re-appreciate their bodies over time.

She further explains, “It’s difficult as a survivor to feel the normal lumpiness of a healthy lactating breast and not think about tumors. Changing your perspective on this takes time, but it is so worth it. Finding a compassionate and knowledgeable IBCLC can be an important piece to reframing your own narrative.”

Emotional support, specifically, will always be important, says Georgalopoulos, “as moms may have varying triggers, trauma, and lifestyles that require many follow-up appointments, and [these factors] may complicate the intention to breastfeed.”

A great place to seek resources for support is through your team of physicians, including your oncologist, obstetrician, or lactation consultant. Ask for recommendations based on your current circumstances and personal goals for your breastfeeding journey.

Potential Risks to Mom or Baby

A common question for women with a history of cancer, especially if treatment is recent, is how long they need to wait before breastfeeding is considered safe.

“Cancer cannot pass through the breast milk in a way that would cause a baby to have breast cancer,” ensures Georgalopoulos, adding, “Chemotherapies and certain medications do need to be out of the system prior to providing breast milk.”

However, it’s important to note that health care experts recommend women who received breast cancer treatment wait before trying to get pregnant.

“The recommendations for waiting post-treatment mostly revolve around the risks of early conception more than breastfeeding specifically,” explains Dr. Ferry. “Experts generally recommend that breast cancer survivors wait between one and three years after treatment to try and conceive. Once mom’s physician has deemed that conception will be safe and feasible, breastfeeding should be recommended at the time of delivery.”

Outside of these time constraints for providing safe breast milk, there are no known risks of breastfeeding after breast cancer. In fact, the opposite is true, claims Georgalopoulos.

“Hormones involved with lactation also keep estrogen levels in check, so in the case of cancerous cells that are directly related to estrogen blood levels, breastfeeding actively lowers the risk of these types of cancers.” What’s more, she says there’s evidence that shows “women who have accrued seven years or more of breastfeeding/lactation in their life have [even lower chances] of developing breast cancer pre- or post-menopause.”

Breastfeeding has been known to lower the risks of developing certain diseases, and the same can be said for moms with a previous history of breast cancer, too, though there are a few caveats to note.

“After already having cancer, risk reduction for recurrence is also possible. However, many young women of childbearing age get breast cancer because of a gene mutation, [such as] BRCA1 and BRCA2, though there are likely many more mutations that affect risk factors for breast cancer,” explains Peluso. “If you are at very high risk of breast cancer because of a mutation, that risk remains high even if you breastfeed, although likely lower than not breastfeeding.”

Unfortunately, she says breast cancer research on recurring risks for breastfeeding women is lacking and advises current patients to find a breast specialist who is well-versed in mammograms and MRIs for lactating mothers in order to best interpret the results while “understanding how lactation can affect changes in the breast and images.”

There’s no denying that breastfeeding after breast cancer comes with challenges, but the important takeaway is that it is possible and should be encouraged, says Dr. Ferry.

“This may require multi-level support and expert advice. Moms should receive counseling on the benefits of breastfeeding and the types of resources available to them. Additionally, early support is important, and should include early skin-to-skin, frequent feedings, and use of a hospital grade double electric pump as strategies to initiate lactation.”