Is tongue-tie surgery necessary? A look into the controversial infant surgery

Breastfeeding can be challenging and emotionally tolling for many new mothers. Although breastfeeding is frequently referred to as a “natural” process, it is also a skill that both the mother and the baby must acquire, according to research published in the National Library of Medicine.

One common problem that mothers face when trying to breastfeed their babies is getting them to latch properly. Shannon Kelleher, a biomedical and nutritional sciences researcher at the University of Massachusetts Lowell, told National Geographic that getting a baby to latch is more complex than you might think.

“It’s really a finely tuned orchestration of different hormones that are binding to their very specific receptors and driving very specific reactions,” Kelleher said. “Anything that interferes with these reactions ‘will shut down lactation, sometimes within hours.’”

Some distressed mothers have turned to tongue-tie surgery as a solution to their breastfeeding struggles.

Although not a new medical procedure, from 1997 to 2012, there was an 800% surge in tongue-tie surgeries in the United States, with the procedure becoming a lucrative practice for some medical professionals, according to a study published in PubMed Central.

What is tongue-tie surgery?

Babies sometimes undergo tongue-tie surgery, also known as a frenotomy, to correct a condition known as ankyloglossia.

“Tongue-tie, also known as ankyloglossia, is present when the lingual frenulum hinders the proper movement of the tongue,” lactation consultant Abbey Cusimano-Imhof told Franciscan Health.

Ankyloglossia is when a baby is born with a tight, short or thick tissue that connects the tongue's underside to the mouth's floor. This condition can limit the tongue's movement, leading to various issues, particularly with breastfeeding.

“The doctor examines the lingual frenulum and then uses sterile scissors to snip the frenulum free. ... If any bleeding occurs, it’s likely to be only a drop or two of blood. After the procedure, a baby can breast-feed immediately,” the Mayo Clinic explained.

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Is it actually necessary?

Tongue-tie surgery, or frenotomy, is controversial in the medical community and among parents.

According to The New York Times, an increase in diagnoses and treatments is often driven more by consumer demand and social media influence than by hard medical evidence. This trend has led to surgeries being performed for cases that might not actually require intervention or where less invasive alternatives could be effective.​

“We have seen the number of tongue-tie and upper-lip tether release surgeries increase dramatically nationwide without any real strong evidence that shows they are effective for breastfeeding,” Christopher Hartnick, director of the Division of Pediatric Otolaryngology at Mass General Brigham, told Harvard Medical School.

Research published in Jama Otolaryngology-Head and Neck Surgery found that in a study of 115 infants who were referred for tongue-tie surgery, 63% of them did not require the surgical procedure to improve their breastfeeding after all.

Initially recommended for surgery, these infants were able to breastfeed effectively after receiving assistance from specialists and undergoing comprehensive feeding assessments conducted by clinicians and speech and language therapists.

“We don’t have a crystal ball that can tell us which infants might benefit most from the surgeries, but this preliminary study provides concrete evidence that this pathway of a multidisciplinary feeding evaluation is helping prevent babies from getting this procedure,” Hartnick added.

Breastfeeding tends to improve over time, regardless of whether surgery is performed or not, which complicates determining the direct impact of the procedure, The New York Times said. Parents should seek multiple opinions, particularly from professionals experienced in dealing with tongue-tie, before deciding on surgery.