Many women know breastfeeding issues are common, but they don’t always know they can see someone like me for help. I’m Dr. Joubin Gabbay, a board certified plastic surgeon from Beverly Hills, and one of my specialties is managing breastfeeding issues. I recently worked with Whitney through her breastfeeding journey, so she asked me to share what I do.
First, as a board certified plastic surgeon, I have lots of experience with breast surgery—breast augmentations, reductions, and reconstructive surgery. That means I know the anatomy and physiology of the breasts inside and out. I also happen to understand a mother’s desire to breastfeed because I’m a father of two beautiful children and my wife experienced her own challenges with breastfeeding. It was through her experience that I realized I could help.
I work with an exceptional nurse lactation consultant named Linda Hannah and a team of specialists to address all aspects of care for breastfeeding women.
The process goes like this:
- In the hospital, many new moms are offered care by an in-house lactation consultant or receive good breast-feeding practices from their nurses, doctors, doula, nanny, etc..
- When a mom has trouble breastfeeding, she will occasionally be referred to a lactation consultant.
- The lactation consultant will help evaluate how the baby latches, how the mom positions the baby during feeding, if there are any physical barriers to breast-feeding (tongue adhesions, nipple problems, breast issues, etc.) and will give guidance on how to optimize the breast-feeding process.
- If challenges persist or if there are issues that must be addressed, the mom and/or baby may be referred to a specialist for further help.
One of those specialists is me.
As a specialist in breast surgery, my goal is to fix any roadblocks the milk might face on its way from mom to baby.
Here’s a quick overview of how the milk delivery system works:
- The first step starts with good hydration and nutrition.
- The water and nutrients are sent by the bloodstream to the “lobules” in mom’s breast tissue.
- The lobules are the factories that make milk and then deliver the milk into the ducts.
- The milk ducts are like a system of little streams of milk that join together in bigger and bigger rivers, eventually emptying out of the breast through the milk duct at the nipple. There are about 6 to 18 individual milk ducts (“big rivers”) that empty out separately through the nipple.
At every step of the way, there are situations that may prevent enough milk from getting to the baby. My job is to try and figure out where that problem is and fix it.
Also, there are a number of conditions that affect the breast outside of this “Milk River” system that may require my care:
- Milk duct obstruction (from trauma, “blebs,” etc.)
- Breast infections / abscesses
- Nipple or breast wounds
- Poor milk production or delivery due to prior breast surgery
In some cases, these conditions need a medical or surgical intervention, but in the vast majority of cases, good advice and careful guidance is all that is needed.
A challenging issue I occasionally chime in on is the decision to stop breastfeeding if the mom is having difficulties. I am an avid supporter of breastfeeding, but as a physician, I also have a duty to guide my patients to make the best choices for them. Sometimes the decision to stop breastfeeding is clear and easy, other times it can be exceptionally difficult and emotionally devastating.
The most important message I can give to anyone involved in the breastfeeding process (yes dads, that includes you!) is this: you are NEVER alone! Breastfeeding is an incredible experience for mom, baby and everyone in the baby’s life, but it can definitely throw you some challenges.
By the time a mom comes to me, she normally has already seen a lactation consultant, doctor, nurse, or other healthcare professional, and has started to see all the help that is available to them. Unfortunately, I know in so many more cases, there are moms out there who feel they don’t have anyone to turn to for help. It shouldn’t be that way! There are tons of options to help fix your challenges and get you through tough times, so don’t give up on breastfeeding if you don’t want to!
As advocates for moms, babies and families, the job of the lactation team is to help with breastfeeding issues whenever possible, but, equally importantly, make it clear that nobody has to go through this process without support and guidance. We’re here for you every step of the way!