Everyone experiences their own challenges when it comes to breastfeeding. But Bo Smith came up against a particularly difficult one: breast cancer. In a moving post on Facebook, Smith shared a photo in which she was nursing her newborn son after having a mastectomy, with a scar across her left breast proudly on display.
"'Never be ashamed of a scar. It simply means you were stronger than whatever tried to hurt you,'" Smith, 32, wrote on Facebook last month. "I can’t begin to explain how this feels everyday to be able to breastfeed my son, after losing one breast to cancer and being told I may not ever have this sweet boy in my arms. I am not ashamed of this body. This is what continues to remind me of how lucky I am to be here today."
Smith, from Sugar Land, Texas, was diagnosed with inflammatory breast cancer in February 2015 and told by doctors she only had a 40 percent chance of living for five years.
"I was devastated and scared," Smith tells SELF. “But I also knew I had no other choice but to fight. I was only 29, and I knew I still wanted to do so much with my life.”
And so she underwent 16 rounds of chemotherapy with six different drugs, a mastectomy to remove her left breast, and 44 rounds of radiation, after which Smith was told she'd had a complete pathological response, and that there was no evidence of the disease.
Before Smith started her treatment program, her doctors checked her fertility and established that she had a diminished ovarian reserve, suggesting that becoming pregnant would be a challenge. “I cried,” Smith says. “I had held on to so much hope that I would still be able to conceive.”
Smith says doctors advised her and her fiancé, James Cofer, to start IVF. But they chose to try naturally first, with the help of the oral medication letrozole, a hormonal therapy drug used to treat certain types of breast cancer, which may also be prescribed as a fertility treatment for women with ovulation problems or unexplained infertility. Two months later, Smith was pregnant. “I was shocked,” she says. “I didn’t think it would happen, let alone so quickly and easily. It was the most amazing feeling.”
On August 18, 2018, baby James was born—and Smith knew that her decision to keep her right breast was the right one. “Breastfeeding has been amazing,” she says. “It’s still so surreal to me that I am a mother and that I am breastfeeding my child, when I wasn’t sure I would even be alive.”
It’s possible for some people to breastfeed during or after breast cancer treatment, depending on the type of treatment.
Treatment for breast cancer is different depending on the type and location of cancer you're dealing with. But, in general, it may include surgery (to remove just the tumor, one breast, or both), chemotherapy (in which drugs are administered in order to kill cancer cells, prevent cancer from spreading, or to slow the growth of cancer) and radiation therapy (in which intense beams of energy are used to kill cancer cells).
Breastfeeding during chemotherapy is "never safe," Michael T. Cappello, D.O., a neonatologist at Advocate Children’s Hospital in Park Ridge, Illinois, tells SELF. "Many of these medications may accumulate in high levels in breast milk and be harmful to the baby.”
But during radiation, it may be OK, depending on "the part of the body that is receiving the radiation therapy,” Dr. Cappello says. The most common form of radiation therapy is called external beam radiation, and it's generally considered safe to breastfeed while receiving this type. But other types (such as brachytherapy, which occurs internally via an implant), may come with more risks.
After a mastectomy, you're highly unlikely to be able to breastfeed on the affected side because the remaining tissue won't produce much (if any) milk, Jennifer Litton, M.D., associate professor in the department of breast medical oncology at the University of Texas M. D. Anderson Cancer Center, tells SELF. So, if you undergo a double mastectomy, it almost certainly isn't going to happen. But, if you opt for a lumpectomy or single mastectomy (as in Smith's case), breastfeeding may still be possible with the unaffected breast.
Whether or not that will be enough is another question. “One breast may be able to provide sufficient quantities of milk for a baby,” Dr. Cappello says, but not always. “To ensure the maximum production with one breast, it is advised to nurse as frequently as possible and to pump after feeding as a way to increase milk production.”
Sometimes, supplementation is necessary if one breast does not provide enough milk for the baby. Ashley Colberg Sabo, M.D., pediatrician at Advocate Children’s Hospital in Oak Lawn, Illinois, tells SELF that she would have to carefully monitor the baby's weight gain to see if supplementation was required.
Of course, many patients undergo a combination of these types of treatment, which may make timing a little more complicated. Although circumstances can vary widely between patients, it may be "several months" after treatment before your doctor says it's OK to breastfeed, Dr. Litton says.
The possibility of breastfeeding during or after treatment depends on each individual's circumstances, so it's important to have a thorough discussion with your oncologist if you're interested in doing this.
“There may be some challenges to breastfeeding after a mastectomy, but breastfeeding is always very beneficial to the baby and definitely still worthwhile [to pursue],” Dr. Colberg Sabo says.
There are ways to plan ahead so that you can still breastfeed during and after cancer treatment, despite the difficulties. If you're already nursing and need to start chemotherapy, you may decide to wean your baby before treatment or pump breast milk and throw it away (“pump and dump”) during therapy so that milk production continues and breastfeeding may be resumed after the oncologist assures you it’s safe to do so, Dr. Cappello says.
However, many patients are prescribed anti-estrogen drugs during or after cancer treatment (possibly for up to a decade), which would need to be discontinued before breastfeeding or becoming pregnant, Dr. Litton says. So, again, the best thing to do is have a conversation with your doctor about your options and your timing. "I have patients who were diagnosed very young and were off their therapy and went on to breastfeed successfully," she says. "It's just a very personal decision."
For Smith, sharing her now-viral breastfeeding photo on Facebook was simply part of her desire to share her story as a cancer survivor. “When I was diagnosed, I shared everything, I didn’t hold back,” she admits. But even she has been amazed at the response. “I never expected this amount of attention, and it has been extremely supportive and positive,” she says.