As breast augmentation, commonly known as a "boob job" or breast implants increases in popularity, the surgery has begun to play a significant role in breastfeeding rates throughout the U.S. and around the world. A generation ago, when breast surgery was rarer and the hazards of artificial baby milk (formula) were less understood, it may have been simpler to tell women that had augmentation to bottlefeed. But with implants now the most popular surgery in the United States (one statistics website said an augmentation is performed every 2 minutes!), with augmentations often taking place prior to childbearing, and with increased knowledge about the deficiencies in formula compared to breastmilk, this is simply unacceptable as a health care/public policy approach.
There are a number of surgical factors that influence ability to produce sufficient milk after breast implants. The most obvious one is the cutting of milk ducts. Interestingly though, after breast surgeries, milk ducts can regenerate. After breast reduction, for example, if more than 5 years have past, chances of breastfeeding have been shown to increase. But less obvious and just as important is the cutting of major nerves within the breast. Even if the milk ducts are largely undisturbed, there are messages that are sent from the nipple to the pituitary gland when the baby nurses that tell the body to produce milk. If this pathway from the breast to the brain and back again is cut, the stimulation message will not reach its destination. Another factor can be pressure placed by the implant on the milk producing tissue or the nerves, compressing the ducts and reducing supply or slowing or stopping nerve messages.
Certain types of surgeries and attention to preserving the breastfeeding supply and messaging systems can increase the odds of exclusive or partial breastfeeding success. Incisions around or across the areola (the dark area surrounding the nipple) are more likely to damage ducts or nerves. Submammary incisions (under the breast where the breast meets the chest) are less likely to cause problems with ducts -- but the surgeon must take care to try to avoid major nerves. Insertion of the implant through the armpit are even less likely to cause problems if nerves are avoided.
Placement of the implant can also have an impact. Augmenting in front of the chest wall, just behind the milk ducts is more likely to cause compression or interference. Implants placed completely or partially behind the chest muscle have better odds. Relative surgical risks of the different types of procedures and placements, however, need to be discussed with the surgeon, as different methods carry different risks aside from the risk or benefit to breastfeeding likelihood. But future effects on breastfeeding should be understood and discussed by both patient and doctor.
If breastfeeding is important to you, and the surgeon says "Oh, implants haven't been shown to affect breastfeeding," it might make sense to find a doctor that is more knowledgeable on this subject. While some women can breastfeed exclusively with no problems, certainly implants can have a negative effect on ability to nurse or to nurse without supplementation.
For information and guidelines for nursing with implants, see my related article "Breastfeeding with Breast Implants," linked below.
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