There are several breast problems that may affect a mother's ability to breastfeed. These include congenital lack of glandular breast tissue and breast surgery, including biopsies, breast augmentation, and breast reduction. A very small percentage of women are born without enough glandular tissue in their breasts to produce a full milk supply for their babies. Often, one breast will look very different from the other, and the mother reports never experiencing normal breast enlargement during pregnancy. These mothers can still breastfeed, but will need to offer supplements with a bottle or feeding tube.
Any woman who has had breast, chest, or cardiac surgery should check with her surgeon to see if any functional breast tissue was affected by the procedure. Breast augmentation usually doesn't involve severing milk ducts or destruction of functional breast tissue, and is usually compatible with lactation. On the other hand, breast reduction is a much more invasive surgery that almost always has an adverse effect on lactation. The impact on lactation depends on the type of reduction surgery done, with the transplantation technique (involving removing and reattaching the nipple and severing all the milk ducts) almost always making lactation impossible, while other techniques that are less invasive may allow full or partial breastfeeding. A lot depends on whether or not the surgeon who performed the procedure made a deliberate effort to leave the blood supply and nerve pathways intact. The mother who has had or is considering breast surgery needs to discuss the details of the procedure and it's effect on her ability to lactate with her doctor. Mothers who have had breast surgery need to closely monitor the baby's weight to establish the potential need for supplemental feedings.
Medical problems in the infant can also cause problems with nursing, but these conditions rarely contraindicate breastfeeding. On the contrary, infants who are ill need the many nutritional and immunological benefits of breastfeeding even more than healthy infants, except in rare cases. One of these rare disorders is galactosemia, a hereditary metabolic condition that occurs once in every 85,000 births. Galactosemia is a deficiency in the liver enzyme that metabolizes lactose. It is one of the few situations that requires total and immediate weaning, because all foods containing lactose (including breastmilk) must be completely eliminated from the baby's diet and replaced by a special formula.
Babies are often incorrectly diagnosed with "lactose intolerance" when they exhibit signs of fussiness or colic. True lactose intolerance is rare, and occurs when an infant is born with a primary lactase deficiency. This means that he is born without any lactase, the enzyme needed to break down lactose, or milk sugar. In this rare situation, the baby will be unable to process the lactose in milk and must be fed a special lactose-free formula in order to survive. Lactose intolerance is caused by a slow decrease in the body's production of lactase, and occurs gradually over a period of many years. The symptoms don't appear before the age of four or five, and usually not until young adulthood. Transient (temporary) lactose intolerance occurs when a baby suffers from prolonged diarrhea (this is much less common in breastfed than in formula fed babies, but it can occur). This type of "nuisance diarrhea', caused by intestinal illness, antibiotic treatment, excessive consumption of fruit juice, or sensitivity to solid foods, can cause the lining of the baby's intestines to become irritated. It usually clears up within two to four weeks. The best treatment for this condition is to continue breastfeeding . Human milk is a natural fluid that is quickly and easily digested, and is the best food to give babies with diarrhea. In cases of transient lactose intolerance, time -- not weaning -- is the best solution.