I see women of all ages in my Fort Worth office for cosmetic and reconstructive breast surgery. The issue of breastfeeding comes up often. It’s a topic worth reviewing.
Breast Implants and Breastfeeding
There are a number of factors to consider when undergoing breast augmentation. Where the implants are placed, through which incision, and the size of the implants all play a role.
Breast Implants In Front of the Muscle or Behind
Before inserting a breast implant, I create a pocket for the implant. The pocket is created behind the breast tissue. In most cases the pocket is placed behind the pectoralis muscle as well. The pectoralis adds a layer of tissue between the implant and the deep surface of the breast tissue. Sometimes an implant is placed in front of the muscle. In that case it is closer to the deep surface of the breast tissue. Does it make a difference whether the implant is behind the muscle or in front of it?
A study from Brazil in 2018 looked at women who had breast implants who also had newborn babies. That study showed women who have implants in front of the muscle have more trouble breastfeeding in the first month than women without implants or women with implants behind the muscle. It also showed women who have implants in front of the muscle had more pain immediately after childbirth than the other groups.
A study out of France in 2019 found that 82% of women who had breast implants behind the muscle were able to breastfeed, while only 17% with implants above the muscle could do so.
Does the Incision Used for Breast Augmentation Affect Breastfeeding?
The short answer: maybe. The results in published studies are mixed. Some studies indicate that implants placed through incisions along the creases below the breasts are less likely to result in problems breastfeeding than incisions along the lower borders of the areolas. Incisions along the lower borders of the areolas may disrupt some of the milk ducts. Disruption of the ducts may make breastfeeding harder.
Does Breast Implant Size Affect Breastfeeding?
In what may be the largest study to date, the answer seems to be ‘no’. Published in 2019, the study reported on over 4500 women who had breast implants and gave birth. About 19% of women who had implants less than 400 cc’s had difficulty breastfeeding. Similarly, about 20% of women with implants larger than 400 cc’s could not produce enough milk to successfully breastfeed. This was true regardless of whether the implants were filled with silicone or saline.
The Amount of Breast Tissue Matters
Some women who have a moderate amount of breast tissue decide they would like to have more. More shape, more volume. However, a lot of women who undergo breast augmentation don’t have much tissue at all. If someone doesn’t have much breast tissue, she may not have enough tissue to produce enough milk to successfully breastfeed a baby.
Breast Lifts, Breast Reductions, and Breastfeeding
Breast lifts (mastopexies) and breast reductions are similar procedures. They are done using similar incisions. However, breast reductions result in the removal of breast tissue, while breast lifts often do not.
A study from Italy indicated that about 50% of women could breastfeed after undergoing breast reduction. Other studies have indicated up to 75% of women can breastfeed after breast reduction surgery.
Does Breastfeeding Affect the Result of Breast Augmentation, Breast Lift, and Breast Reduction?
Yes, it does. Breast tissue is still present after these procedures. Hormones of pregnancy affect any breast tissue that is present. Breasts tend to become enlarged during pregnancy. They may remain enlarged for a period of time after pregnancy. Over time, if someone hasn’t gained much weight, the breasts tend to become smaller. The skin becomes loose. Tissues may sag a bit. This has nothing to do with the surgery, but rather just the normal responses to hormones. How much a woman’s breasts will change is not predictable. However, they will change.
A woman who might want to have more children should consider all of the above information before undergoing breast surgery. Breast augmentation, breast lift, and breast reduction may all produce wonderful results. The surgery affects sensation and there are some concerns about being able to breastfeed. Similarly, pregnancy affects the results.
