Introduction

Have you ever seen a child with a tongue-tie struggling to feed and the mother also going through a lot of stress trying to ensure her baby feeds well despite her pains? Trust me, it's not a good experience.

Have you wondered if a tongue-tie surgery can help this baby and mother? Your answer may be a yes but you still wonder if the benefit of this surgery is worth taking the risk, especially with the cost of surgery and risk associated with the surgery as well as the anaesthetic effects on the baby.

This article was written to help you understand what tongue-tie is, its impact on breastfeeding, if it requires surgery, and what kind of surgery is best for correction, as well as the effect of this surgery on breastfeeding.

Let's dive in and see if your questions will be answered.

What is tongue-tie?

Tongue-tie (ankyloglossia) is an abnormality in the development of the membrane that holds down the tongue from the tip through the back to the base of the mouth, called the lingual frenulum. This frenulum helps with the movement of the tongue but when it is abnormally short, tight, or thick it results in what is called tongue-tie.³ The exact cause of tongue-tie is not so clear, however, some have said that it's both genetic as well as environmental. Genetic, because you can find several recurrences in families. Many also believe that tongue-tie occurs when the lingual frenulum fails to regress completely when the fetus develops. It can occur in both males and females. It is said to be present in about 4-10% of the general population.⁵

Tongue-tie is usually classified based on its severity (from mild to severe) following the assessment of:⁵

• Movement of the tongue,
• Function of the tongue, and
• The impact of tongue-tie on the quality of life

How does tongue-tie affect breastfeeding? 

Several researches have shown that tongue-tie is strongly associated with difficulties in breastfeeding. Problems identified to be associated with tongue-tie include:^2,3,4

• Latching and sucking problems
• Pain in the nipple for mothers
• Poor milk transfer
• Irritability of both mother and baby, makes breastfeeding frustrating for both of them
• Early weaning of the baby

Why you should consider tongue-tie surgery (frenectomy/frenuloplasty) for breastfeeding challenges

While the indication for performing these tongue-tie surgeries is not so clear,  research has shown that tongue-tie surgeries have helped in reducing the unnecessary prolonged stress mothers of babies with tongue-tie, as well as the babies themselves face as a result of this problem.^2,3 It does this by improving the breastfeeding problems, which in turn helps with better nutrition and weight gain for the baby.⁵

However, tongue-tie surgery is not recommended if:⁵

• The tongue-tie does not cause any problem to the baby or mother, for example, in mild tongue-tie
• Supporting breastfeeding measures like proper latch techniques and proper positioning of the baby works 

Types of tongue-tie surgery?

There are two types of tongue-tie surgeries commonly done. They include:³

Frenotomy/Frenulectomy/Frenectomy 

The aim of frenotomy (clipping of the frenulum partially) or frenectomy( total removal of the frenulum) is to improve the mobility and function of the tongue. It is usually done without anaesthesia and encouraged in babies less than 4 months of age. This procedure can be done using either the traditional or modern method.⁵

• Traditional, the old use of scissors and scalpels
• Modern, the use of lasers

Before choosing the method to use, it is important to think about the following:⁵

• Pain 
• Bleeding, and 
• Timing for healing

However, every choice has its advantages.⁵ Post frenotomy, bleeding is usually not much and can be controlled once pressure is applied. The baby is usually allowed to eat immediately and given paracetamol to relieve the pain. No other medication is needed.

Frenuloplasty

Frenuloplasty is an attempt to lengthen the frenulum. It can be done under general anaesthesia in babies above 4 months of age.³ Here, the surgeon cuts the frenulum and then tries to suture it back to lengthen it and allow for better movement.⁶

Post surgery, babies are given paracetamol for pain and encouraged to feed as tolerated. Infection is rare so prophylactic antibiotics are not usually prescribed. However, early tongue movement is encouraged to reduce the risk of scar formation and improve the range of movement of the tongue.⁶

Older patients are usually asked to do tongue exercises 3 or more times daily, beginning from 1 week after surgery. Follow-up visits at 3 months after surgery are also important.⁶

In both cases, recovery is relatively short. However, the healing process may differ for individuals.

What are the possible complications of tongue-tie surgeries?

Complications are very rare. However, occasionally they can present with:⁶

• Bleeding
• Infection
• Scarring, resulting in repeat tongue-tie
• Tongue swallowing due to long mobility of the tongue
• Injury to salivary glands
• Speech problems in those who didn't have such previously or new speech problems in those who had surgery before as a result of possible injury to nerves in the mouth

What breastfeeding changes or benefits will you see after a tongue-tie surgery?

The changes/benefits you will see in breastfeeding can be:

• Early/immediate, within weeks to months
• Late/long-term, within months to years 

Early/Immediate breastfeeding benefits 

After a tongue-tie surgery, you will notice some immediate/early changes in the quality of breastfeeding and the timing of breastfeeding. The changes are usually improvements as opposed to before surgery, and they are positive. These changes can be seen from as early as the week after surgery. However, they improve over time in the first month. They include:¹

• Reduction in nipple pain for mothers due to reduced compression on nipples
• Milk transfer is better since the baby can suck and extract milk more
• Latch is better as the babies can now extend their tongues and latch deeper
• Baby spends a shorter time sucking and gets enough milk within that time
• Reduction in feeding frustration by the mother or baby

Late/Long-Term breastfeeding benefits

• Babies begin to get enough milk and therefore their weight begins to improve
• As milk removal gets better, a healthy milk supply is sustained
• Mothers begin to enjoy breastfeeding their babies and are more likely to breastfeed for longer, reducing the risk of weaning their babies early
• Mother and baby bond better as breastfeeding becomes more fun

What are the possible challenges after surgery?

• The baby or infant may need to learn how to use the tongue properly following release
• Some babies may be irritable for a few days after surgery

When do you need a doctor after tongue-tie surgery?

• If you notice any complication, e.g pus formation as in infection or bleeding
• If you have any questions about care

Summary

• Tongue-tie is a very common condition that affects breastfeeding, and if it presents with breastfeeding difficulties it can be managed by surgery, which is capable of improving the problem both mothers and babies are facing
• For breastfeeding to be successful, tongue-tie must be diagnosed early enough, and a proper decision as to whether surgery is required or not must be made 
• Parents and the provider of health for the baby should work together to make the best decision for breastfeeding to be successful
• Tongue-tie surgeries are very safe and effective. The success rate has been high and impressive, and improvements have also been noted with breastfeeding after those surgeries
• Complications are uncommon, however, they sometimes present with excessive bleeding, infection, scarring, speech problems, and injury to the salivary glands
• With proper care and support post-surgery, the baby will do very well with breastfeeding

FAQs

What is tongue-tie?

Tongue-tie occurs when the membrane under the tongue (lingual frenulum) is short, tight, and thick reducing movement of the tongue.

Does tongue-tie affect breastfeeding?

Tongue-tie may sometimes cause breastfeeding problems like poor latch, poor milk transfer, inappropriate weight gain in babies, and nipple pain in the mother.

How do I know my baby has a tongue-tie?

What you will notice include:

• The baby is unable to latch well
• Hearing a click sound when the baby is sucking
• Cracked nipples with associated pain in the mother
• Baby is very irritable when sucking
• Baby not gaining weight despite staying very long sucking

To confirm, you can take the baby to the doctor or any health worker.

What is tongue-tie surgery and how is it done?

Tongue-tie surgery (frenotomy, frenectomy, or frenuloplasty) involves cutting the frenulum or removal or release of a tight frenulum.

Is tongue-tie surgery usually painful for babies?

The baby may experience some pain. However, with the use of paracetamol and breastfeeding, babies can be consoled.

How soon will I notice breastfeeding changes after surgery?

It varies for individuals. You may begin to notice some little changes immediately after surgery; sometimes it may take some days but, by 3 months after surgery, there should be very obvious changes.

Can tongue-tie grow back after surgery?

The answer is NO. What may happen is a reattachment of the frenulum due to improper healing, causing symptoms that are very similar to those before the surgery.

Are there risks of surgical complications?

The risk of having complications is very rare. However, sometimes babies may present with exclusive bleeding, infection, injury to nerves of the mouth and the salivary glands, and scarring, which may result in a recurrence of tightening.

Will tongue-tie surgery always be required?

No, babies and mothers without breastfeeding problems will not require surgery. Especially in cases that are mild, where the mother and baby can cope well with supportive measures like proper positioning and latching techniques.