implants and Breast feeding

While a variety of women come into my office seeking breast augmentation surgery, they tend to form two groups - young women with smaller breasts who have not yet had children and women who have finished child bearing and are seeking to rejuvenate their breasts.  If you have already finished having children – congratulations on experiencing one of life’s miracles!  If not, then read on: 
If you are considering having breast implants and wish to have children in the future, what important things to do you need to know?

1. What are the current recommendations on breast feeding and breast surgery?
2. What is the evidence on women being able to breast feed after breast augmentation surgery?
3. What does this ultimately mean to me?

1. The World Health Organization currently recommends EXCLUSIVELY breast feeding for the first six months after birth.  After this breast feeding is recommended up to two years (or longer) in combination with nutritious food (1).  Advantages of breast feeding include lower risk of gastrointestinal infections for the baby and long-term benefits such as a lower chance of Type-II diabetes and performing better on intelligence testing.  Benefits for the mother include faster weight loss and decreased risk of developing breast cancer (2).

2.  Current evidence suggests that many women can breast feed after breast augmentation however are more likely to have to supplement, i.e. not be able to EXCLUSIVELY breast feed.  (3,4) There has been some suggestion that certain techniques may impact the chances of being able to breast feed more, such as a using a peri-areolar incision (5,7), or putting the implant in a subglandular plane (7).  The biggest issue with these studies is not knowing if these women had implants put in because of a lack of breast development, meaning that they would have had difficulty breast feeding regardless of whether they had implants or not.  There is no contraindication to TRYING to breast feed if you have already had implants put in.

3. While women may not choose to breast feed their children or encounter difficulty, we do know rates of breast feeding have been increasing throughout the years as the health benefits become better understood, going from about 25% in the 1960s to 85% more recently.  Only about 50% of women breast feed their children for six months or more and even less do so exclusively.   Reasons for stopping breast feeding include not enough milk, the child weaning itself, having to return to work/school or fatigue (8).   While the science suggests that most women should be able to breastfeed after breast augmentation, they may have difficulty producing milk and will have to supplement with other sources of food.  Again, we do not know if this is a result of having less breast tissue to begin with versus the result of having a breast implant.  

The bottom line is we do not 100% know.  If considering breast augmentation and potentially having children down the road, it is important to know that there are health benefits to breast feeding your children and that your ability to breast feed MAY be affected, most likely meaning having to supplement.  The technique of breast augmentation such as using an incision under your breast versus around your nipple and the decision to place the implant under the muscle could help minimize issues with breast feeding.  That being said, if you have already had breast implants,  there is no contraindication to trying to breast feed!  As with any surgical procedure it is important to discuss the risks and benefits with your doctor to decide if this surgery is right for you.

REFERENCES:

1. https://www.who.int/mediacentre/news/statements/2011/breastfeeding_20110115/en/
2. https://www.who.int/features/factfiles/breastfeeding/en/
3. Schiff M et al.   The impact of cosmetic breast implants on breastfeeding: a systematic review and meta-analysis.   International Breastfeeding Journal.  9(17): 1-8.
4. Cheng F et al.  Do Breast Implants Influence Breast Feeding:  A Meta-Analysis of Comparative Studies.  Journal of Human Lactation.  34(3): 424-432.
5. Hurst NM. Lactation after augmentation mammoplasty. Obstet Gynecol. 87: 30-3
6. Neifert M et al.  The influence of breast surgery, breast appearance, and pregnancy-induced changes on lactation sufficiency as measure by infant weight gain. Birth 17:31-38.
7. Bomby et al.  Impact on Breastfeeding According to Implant Features in Breast Augmentation.  Annals of Plastic Surgery.82(1).  11-14.
8. Maclean H, Millar WJ. Breastfeeding practices [Internet]. Ottawa (ON): Statistics Canada; 2005 [cited 2018 May 14]. 54p. Cat. No.: 82-003. Available from: http://publications.gc.ca/Collection-R/Statcan/82-003-XIE/0020482-003-XIE.pdf.

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