Gender affirming procedures and medications can impact lactation in different ways, and the Academy of Breastfeeding Medicine has an open-access clinical protocol on Lactation Care for LGBTQ+ patients as well as a Gender Inclusive position statement detailing these considerations.
Female to male transgender patients may undergo gender affirming “top surgery” to reduce the female appearance of the breast to a preferred more flat chest wall consistent with that of cis males. The volume of breast tissue removed may vary widely among individuals, often based on body habitus and surgical technique. Patients may or may not undergo removal of the nipple and/or areola. If nipple and/or areola is removed, reconstruction, either surgical or via techniques such as tattooing, may occur. Scarring may affect subsequent nipple and areola pliability and sensation. Nerves and/or blood vessels supplying the nipple may or may not have been interrupted, consistent with risk involving all other reduction-type procedures on the breast.
Due to these factors, female to male transgender patients may report variable experiences with engorgement, volume of milk produced, and challenges with latch. They should be referred to lactation support in the prenatal period and followed closely after delivery. In addition, male to female transgender patients who have undergone “top surgery” may experience difficulties similar to those patients who have undergone cosmetic breast augmentation (breast implants). Silicone injections can cause considerable scarring and infection risk both during and before or after lactation, and are not recommended nor legal in the United States.
