Can you breastfeed after cancer treatment?

For many expectant parents, breastfeeding or chestfeeding offers a crucial way to bond with their babies and pass on important nutrients. But many breast cancer patients don’t get this experience. Thanks to different treatment options and new developments, MD Anderson’s Helen Johnson, M.D., wants patients and survivors to know that a breast cancer diagnosis might not mean they can’t breastfeed or chestfeed their child.

Johnson, also an International Board Certified Lactation Consultant (IBCLC), says it’s vital for patients to discuss their wishes with their care team as early as possible so they can develop a treatment plan that accounts for those wishes. We asked her about options for cancer survivors wanting to breast- or chestfeed.

Are certain patients with breast cancer more likely to be able to breastfeed or chestfeed?

Not necessarily. It really has more to do with treatment. Studies looking at patients undergoing chemotherapy show that it impacts the ability of both breasts to produce milk, so a patient may produce less milk overall if they have undergone chemo. They should be aware of that possibility during pregnancy and establish care with a lactation specialist, either a breastfeeding medicine physician or a lactation consultant, before delivery.  

We counsel those who might need hormone therapy not to breastfeed. This treatment involves taking a pill for 5 to 10 years, and those drugs may pass through the bloodstream and into the milk. However, there have been very promising results from a recent trial that evaluated the safety of pausing therapy for up to two years so the patient can give birth and breastfeed successfully. Hopefully, the final data will continue to yield positive results.

What complications might occur for parents wanting to chest or breastfeed after cancer treatment?

Again, it depends on the treatment. Patients having undergone a single or bilateral mastectomy unfortunately won't be able to breastfeed from the affected breast or breasts. If a breast cancer survivor who has had a mastectomy experiences breast growth during pregnancy and/or leaks milk after childbirth, they should be evaluated by their cancer team for residual breast tissue.

Patients who have had breast-conserving surgery, most often a lumpectomy followed by radiation, will produce less milk from that breast. Lumpectomy surgery removes breast tissue and can also disrupt milk ducts and nerves important for breast milk flow. Radiation kills cancer cells and permanently affects how other cells function. The affected breast likely won’t undergo all the normal changes it’s supposed to during pregnancy as a function of radiation. The skin also may not be elastic enough for latching and successful feeding. It may be wise to focus on the unaffected breast. One breast can produce enough milk to feed a baby, even twins.

I recommend visiting with a lactation specialist as early as possible. They can help with so many issues and questions, and they can also help patients struggling to breastfeed or to produce milk with specialized techniques like hand expression or triple feeds. Triple feeding is where you directly breastfeed, then pump, and then feed the milk to the baby. This can help increase supply by increasing demand. Initially, there is some hormonal drive at play, but then breastmilk production purely becomes about supply and demand.

Are there therapeutic options for patients who undergo a bilateral mastectomy, or for those unable to produce breast milk?

Absolutely – it just might not be what they’ve envisioned. Those who are facing or who have undergone bilateral mastectomies will not be able to breastfeed, and those with one breast might not be able to make enough milk. This is common along the spectrum of motherhood without a history of breast cancer; some people just don’t produce as much milk as others. This is where donor breastmilk can come into play. It’s an option many don’t know about. There are now many organizations with milk banks, and there’s even the option of sharing breastmilk with trusted people you know.

Breast cancer survivors should not start any herbs and medicines to boost milk production without consulting their cancer physicians. Many of these substances are phytoestrogens that could interfere with hormone therapy and possibly impact recurrence risk.

What’s your advice for those hoping to breastfeed after breast cancer?

First, I encourage young patients having breast surgery for any reason to think about this even if they’re not yet planning to have children. While they may have no feelings about breastfeeding now, they might in the future. When I counsel young patients with breast cancer about fertility preservation options and refer them to MD Anderson’s Oncofertility Clinic, it is a natural lead-in to discussing breastfeeding preservation. Our conversation about oncolactation includes discussion about deferring a preventive mastectomy on the healthy breast until after they’re finished with childbearing and breastfeeding. We also discuss why it’s important to meet with a lactation specialist in the prenatal period and be monitored closely in the early weeks of breastfeeding.

Second, in many cases, breastfeeding is possible. Again, it simply may look different than what you imagined. Survivors may need to feed from one breast only and/or supplement with other milk. Those who are unable to breastfeed can still offer their baby the benefits of breastfeeding or chestfeeding through donor breastmilk.

Finally, breastfeeding after surviving breast cancer can be a very healing experience. For many, it represents coming full circle and having a positive experience with their breast and helps them focus on the joy of motherhood, parenthood, and the hope of a new life.  

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