Breast augmentation (breast implants) is the most common cosmetic surgical procedure in the United States (and around the world). Breast reduction is the 8th most popular cosmetic surgery worldwide. Since women often undergo breast surgery
during their childbearing years, knowing the impact it might have on their ability to breastfeed should be part of the consultation with the surgeon beforehand. The research, however, is hard to interpret and surgeons may have a much different definition of successful breastfeeding than lactation consultants or parents do.
It is often thought that breast reduction is much more limiting to breastfeeding than breast augmentation. Any breast surgery, though, has the potential to impact infant feeding. If you are planning breast surgery, or if you have already undergone the procedure, what do you need to know to have the best breastfeeding experience?
"The research, however, is hard to interpret and surgeons may have a much different definition of successful breastfeeding than lactation consultants or parents do. "
The reason for surgery can make a difference
Cosmetic breast surgery is typically done because there’s something you don’t like about the way your breasts look. The appearance of your anatomy, however, might provide clues to whether or not there are underlying issues that might cause milk supply problems during lactation. If your breasts were augmented because they were drastically different sizes, for instance, or if they were just too small, it can mean that you have insufficient glandular tissue (at least on one side) and that can be a red flag signaling you should monitor your baby’s weight gain and your milk supply.
"The most common problem with breast implants is severe (and painful) engorgement."
The type of incision can have an impact
Lactation is a process under the control of hormones which are triggered in part by stimulation of the nerves in the nipple and breast. And once the baby is nursing, milk moves through a branch-like structure of ducts to get to the nipple pores. While improved surgical techniques have led to fewer complications as far as severed nerves or ducts, the possibility that these necessary structures were damaged is always an inherent risk in breast surgery.
The type of incisions that were made for your surgery can make a big difference. If you’ve already had surgery, the scars on your breasts may provide clues. But discussing the specifics with your surgeon is the best way to know what impact the surgery may have had on breast structures essential for lactation. If you haven’t had surgery yet, discussing with your surgeon your future desire to breastfeed can help them plan for the best outcomes before surgery by using nerve and duct sparing techniques.
The following are the most typical incisions for breast augmentation and reduction:
Inframammary: the incision is made in the fold under the breast for placing an implant. This tends to have less impact on breastfeeding, especially if the implant is placed behind the muscle.
Transaxillary: the incision is made in the underarm and the implant is placed in front or behind the muscle. Because the breast tissue itself is not touched, this method may be more compatible with breastfeeding.
Transumbilical: the incision is made in the abdomen near the belly button. While the breast is not cut during this procedure, the underlying tissues are often damaged as the implant is maneuvered into the correct position.
Periareolar: the incision is made around the areola. Often this leads to a loss of sensation and may have the most impact on breastfeeding due to the nerve damage.
Pedicle techniques: These breast reduction techniques move the areola and nipple to a higher position while keeping the tissue underneath (glands, ducts, nerves and blood supply) intact. There are a variety of methods for doing this, and some are better than others for preserving lactation capabilities.
Free nipple graft: This breast reduction technique severs the nipple and areola completely to place it in a more favorable position as the breast is reshaped after tissue is removed. This will most likely impair breastfeeding.
In addition to the surgical incision, the location of a breast implant may impact feeding. An implant can be placed in front or behind the muscle. When implants are placed under the muscle, there is less chance that the implant itself or the techniques used to place the implant will exert a negative influence on the milk-making structures of the breast.
Finally, the size of the implants might make a difference. Larger volume implants are more likely to put pressure on the milk making apparatus than smaller volume implants, causing more milk supply problems. (Cheng et al, 2018; Lund, et al 2016; Schiff et al, 2014)
"According to Bompy et al (2019), 75% percent of women who have breast implants can breastfeed successfully."
Reduction and breastfeeding
Because breast reduction often involves removing tissue, the ability to bring in a full milk supply may be compromised. If the nipple was completely removed, then the woman may not be able to make milk at all. In their evaluation of the research, Kraut et al (2017), surgery that preserves a column of tissue beneath the areola (pedicle techniques) is the most likely to support future lactation, though they note that the quality of the studies they were able to find in their systemic review were of low and counted breastfeeding success as a very short period postpartum (one month).
Implants and breastfeeding
According to Bompy et al (2019), 75% percent of women who have breast implants can breastfeed successfully. That does mean, however, that 25% (or one out of every 4) women with implants will have problems breastfeeding. Wambach and Spencer (2020) find this number may be much higher. Their summary of the research suggests 30% to 60% of women with implants don’t meet their breastfeeding goals. Comparisons between studies are difficult to make as they tend not to use standard definitions of full or partial breastfeeding, and success may be measured much differently between surgeons than among parents.
Some women may be wondering if the implants themselves are safe for breastfeeding. The majority of implants today are gel-filled (as opposed to saline-filled) (Wambach & Spencer 2020). From 1992 to 2006, however, the US Food and Drug Administration (FDA) paused their approval of silicone implants due to concerns over the possibility that the silicone was leaching into breastmilk and causing health complications for babies. Further research did not support this finding and the ban was lifted.
What about other breast surgeries?
Biopsy: Diagnostic procedures like biopsy or fine needle aspiration can impact lactation if they disrupt ducts or nerves, but most often breastfeeding can continue with only minor interruption (if you’re already a nursing parent). If you’ve had a breast procedure in the past (before breastfeeding even started), talk to you doctor to learn more about exactly what was done and whether the ducts or nerves might have been damaged in the process.
Mastopexy: A breast lift, like a face lift, is typically done to remedy sagging. While some women worry that breastfeeding may lead to sagging or drooping breasts after weaning, pregnancy itself as well as natural changes with aging or weight gain, in fact, are more often the culprit (Wambach & Spencer 2020). This surgery involves removing excess skin and lifting the nipple. Though it is often not done during a woman’s reproductive years, like any other breast surgery they type of incision will determine if there is any nerve or duct damage.
How will I know if I’m making enough milk? What can I do if I’m not? What if I run into problems?
No matter how good your IBCLC is, though, they can’t magically make milk ducts grow. But the assistance of a lactation consultant experienced in helping parents with previous breast surgery can be essential.
The most common problem with breast implants is severe (and painful) engorgement. The pressure of the breasts filling with milk may be compounded by the fluid of the implant pressing against the full breast tissue. If this pressure is prolonged, it may signal to your body that not as much milk is needed, leading to low milk supply. Many women ask, then, “How can I tell the difference between breast fullness from an implant vs breast fullness from milk?” It might be difficult to notice during the first few days, but your breasts should feel a little softer after feedings. Genna (2020) suggests women with implants should plan to feed or pump more frequently to keep the breasts from getting uncomfortably engorged.
Your breast pump may become your new best friend. Pumping early and often, along with feeding your baby, can give your breastmilk production a boost from the start. Because milk supply is based on milk removal, you may need to pump between or right after feedings if your supply is low in order to encourage your body to make more milk.
While you’re working on building a milk supply, whether you’ve had breast reduction or augmentation, keep a close watch of your baby’s wet and dirty diapers. Along with tracking your baby’s weight, their output is the best indicator that they're getting enough milk. The number of wet diapers should increase during the first week of life (one pee on day one, two pees on day two, etc.) until your baby is having at least five heavy, wet diapers per day by the end of their first week of life. Your baby should begin having at least three yellow, unformed bowel movements by day three after birth and should continue to have as many each day for the first month or so.
If your milk supply is low, or if all your interventions to increase supply haven’t worked, you can still breastfeed, but you will need to supplement, as well. Using a nursing supplementer, such as the Supplemental Nursing System or the Lact-aid, can streamline your feeding time, allowing your baby to get their supplemental bottle while they are at the breast. (You can also find instructions here on how to DIY one of these devices.)
One of the best online resources for women who have undergone any type of breast surgery is BFAR: Breastfeeding after breast and nipple surgeries. Maintained by a lactation consultant who also had breast surgery in the past, the website is packed with information, references and resources. The associated book, Defining Your Own Success: Breastfeeding after Breast Reduction Surgery may be an invaluable resource on your lactation journey after breast surgery. The book Making More Milk: A nursing mother’s guide to milk supply might also be a good addition to your lactation library.
Need more help? Milk Diva offers in-home, in-office and virtual visits. Our knowledgeable lactation consultants will take a full health history, including learning as much as possible about your breast surgery, to help you plan for meeting your breastfeeding goals.
--->View our free video titled "Surviving to Thriving, During the First Few Days After Birth" here
References:
Bompy, L., Gerenton, B., Cristofari, S., Stivala, A., Moris, V., See, L. A., ... & Guillier, D. (2019). Impact on breastfeeding according to implant features in breast augmentation: A multicentric retrospective study. Annals of plastic surgery, 82(1), 11-14.
Cheng, F., Dai, S., Wang, C., Zeng, S., Chen, J., & Cen, Y. (2018). Do breast implants influence breastfeeding? A meta-analysis of comparative studies. Journal of Human Lactation, 34(3), 424-432.
Filiciani, S., Siemienczuk, G. F., Nardín, J. M., Cappio, B., Albertengo, A. C., Nozzi, G., & Caggioli, M. (2016). Cohort study to assess the impact of breast implants on breastfeeding. Plastic and reconstructive surgery, 138(6), 1152-1159.
Genna, C. W. (2020). Breastfeeding After Breast Implant Surgery. Clinical Lactation, 11(4), 202-206.
Jewell, M. L., Edwards, M. C., Murphy, D. K., & Schumacher, A. (2019). Lactation outcomes in more than 3500 women following primary augmentation: 5-year data from the breast implant follow-up study. Aesthetic surgery journal, 39(8), 875-883.
Kraut, R. Y., Brown, E., Korownyk, C., Katz, L. S., Vandermeer, B., Babenko, O., ... & Allan, G. M. (2017). The impact of breast reduction surgery on breastfeeding: Systematic review of observational studies. PloS one, 12(10), e0186591.
Lund, H. G., Turkle, J., Jewell, M. L., & Murphy, D. K. (2016). Low risk of skin and nipple sensitivity and lactation issues after primary breast augmentation with form-stable silicone implants: follow-up in 4927 subjects. Aesthetic surgery journal, 36(6), 672-680.
Marcacine, K. O., Abuchaim, E. D. S. V., Coca, K. P., & de Vilhena Abrão, A. C. F. (2018). Factors associated to breast implants and breastfeeding. Revista da Escola de Enfermagem da USP, 52, e03363-e03363.
Roberts, C. L., Ampt, A. J., Algert, C. S., Sywak, M. S., & Chen, J. S. C. (2015). Reduced breast milk feeding subsequent to cosmetic breast augmentation surgery. Medical Journal of Australia, 202(6), 324-328.
Schiff, M., Algert, C. S., Ampt, A., Sywak, M. S., & Roberts, C. L. (2014). The impact of cosmetic breast implants on breastfeeding: a systematic review and meta-analysis. International breastfeeding journal, 9(1), 1-8.
Seswandhana, R., Anzhari, S., & Dachlan, I. (2020). A successful breastfeeding after vertical scar reduction mammaplasty with superior pedicle: A case report. Annals of Medicine and Surgery, 60, 600-603.
Wambach, K and Spencer, B. (2020). Breastfeeding and human lactation. 6th ed. Jones & Bartlett, Burlington, MA.
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