LISA J. KORUS MD MPH FRCSC PLASTIC AND RECONSTRUCTIVE SURGERY EDMONTON

​WHAT ARE WE DOING TO KEEP YOU SAFE?
 
While we are excited to return to operating and see patients in our clinic, the safety of our patients is our utmost priority.  These are the steps that we are taking to ensure your safety:
 
Before your visit:
 
We are screening patients as well as our own office staff BEFORE they attend our facilities to ensure that:  
 

• They have not travelled outside of Canada in the past 30 days
• They are not currently feeling ill or have not felt ill for the past 14 days
• They have not cared for someone feeling ill in the last 14 days or have been contact with someone being diagnosed with COVID19
• Are not immunocompromised
• Do not have body aches, fatigue, loss of taste and/or smell and do not have a fever

 
Additionally, we are asking that patients:
 

• Arrive with a mask if possible
• Attend their appointment by themselves is possible
• Arrive at the time booked

 
At your visit:
 

• We are currently booking under capacity to decrease the number of people in the facility at a time and have spaced out our waiting room to comply with social distancing
• We have posted visible information in regards to social distancing and hygiene to remind both office staff and patients alike of precautions that must be taken
• We have hand sanitizer available for use when arriving and leaving the facility
• Common areas are being sanitized with increased frequency and common use items (such as magazines) have been removed
• All surfaces that come into contact with patients through their visit are being sanitized between patients using Health Canada approved disinfectants
• Our staff will be either behind physical barriers (sneeze guards or shields) or be wearing medical grade masks during their interactions with you

 
As Alberta relaunches, it is our duty to ensure that we are able to continue to provide the highest level of patient care while additionally doing what we can to help decrease the spread of COVID19.

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.