News & Features

Can I Breast-feed after Breast Augmentation Surgery?

By Samantha Johnson
April 27, 2012

Breast-feeding after Augmentation Considering breast augmentation before having children? Many women are under the impression they won’t be able to breast-feed after having breast augmentation surgery. This could not be further from the truth. Advances in surgery techniques along with new studies on the ability of the human breast to adapt to surgery show that it is entirely possible to breast-feed after breast augmentation surgery. Informing yourself of your options will be the first step toward breast-feeding success. Some basics you will need to understand are the placement of incision and the placement of the implant which we explain below. If you've already had the surgery and are planning to breast-feed in the future, skip to the end of the article for some important information.

Did you know?

  • Breast augmentation surgery does not prevent your physical ability to lactate, but it can increase your risk for having a low milk supply.
  • An incision placed around the areola (periareolar technique) causes the most damage to the breast ducts and nerves.
  • An implant placed above the pectoral muscle can put pressure on the glandular tissue and thereby reduce milk supply.
  • Nerves and ducts can naturally repair themselves over time through recanalization and re-innervation.
  • The more time that goes by after surgery and before nursing, the better.

  • What aspects of breast augmentation surgery can lower the milk supply?

    When ducts and nerves are cut during surgery, or too much pressure is placed on the glandular tissue from the implant, decreased milk supply is almost always the result. Fortunately, you can choose the placement of incision and placement of implant that will not damage the nerves or tissue necessary for milk production.

    Placement of the Incision

    The four types of incision techniques include periareolar, inframammary, transaxillary and transumbilical. Since the periareolar technique is the most harmful to breast tissue and nerve endings, one of the other choices may be best if you want to breast-feed in the future.
    • The periareolar technique requires an incision around or across a portion of the areola and is usually used in order to hide scarring. However, it can likely sever the fourth intercostal nerve, which is critical to lactation because of its role in triggering the release of oxytocin, which in turn triggers the milk ejection reflex. Ducts and glands are likely to be severed because the incision penetrates deeply through the breast tissue, increasing the risk for a low milk supply in the future. If you have already had this type of surgery, read about recanalization below.
    • The procedure most frequently used is the inframammary technique. The implant is inserted into the fold where the breast meets the chest wall. This technique does not leave visible scars. Inframammary surgery makes less of an impact on the milk supply because the glandular tissue and nerves are not harmed.
    • The transaxillary incision leaves no scars on the breasts. An incision is made near the armpit and is hidden in the natural folds of the skin. Implants are usually placed below the pectoral muscles. The impact on lactation is usually minimal because the glandular tissue and nerves are largely undisturbed.
    • A transumbilical breast augmentation (TUBA) is performed by inserting the implant through an incision in the navel and moving it into place in the breast. No incisions are made on the breast or into the breast tissue, although the breast tissue is disrupted and sometimes damaged as the implant is brought into position. Insertion through the navel makes it difficult to position the implant accurately and requires the use of a camera scope. This technique only allows the implant to be placed above the pectoral muscle. Like transaxillary surgery, the transumbilical procedure preserves glandular function and nerve response; the impact on lactation is usually minimal.

    Placement of the Implant

    "Informing yourself of your options

    will be the first step toward breast-feeding success."

    There are four types of breast implant placements to consider: partial submuscular, submuscular, subglandular and subfascial. The best placement for women who want to breastfeed in the future is usually the submuscular placement because the implants are inserted below the pectoral muscles and do not put pressure on the glandular tissue.
    • Parital submuscular/subpectoral: The implant is placed partially below the pectoral muscle. Because of the structure of this muscle, the implant is only partially covered. Recovery time from this positioning is typically longer and more painful because the doctor has to manipulate the muscle during surgery. Also, because of increased swelling, the implant may take longer to drop into a natural position after surgery.
    • Submuscular/subpectoral: The most common placement; the implant is placed completely behind the pectoral muscle and behind all of the supporting connective tissue and non-pectoral muscle groups. This placement provides better support of the implant, less trauma to the breast tissue, less rippling than subglandular placement. However, this placement has the longest recovery time.
    • Subglandular: The breasts look fuller and rounder because the implants are placed under the mammary glands (between the breast tissue and the muscle). As a result, the implant follows the natural shape of the breast. This placement requires the least complicated surgery and yields the quickest recovery. However, subglandular placement is prone to leakage more often than other types of placement.
    • Subfascial: Implants are placed under the thin layer of connective tissue which covers the muscles of the chest. This is said to help sustain proper positioning of the implant. The subfascial placement gives you most of the benefits of placement under the muscle but also gives a more natural shape to the breast and less distortion with movement.

    Saline vs. Silicone

    There are two types of breast implants: saline and silicone.
    • Silicone: Many women feel that silicone breast implants look and feel more like natural breast tissue, but they pose more of a risk if they leak. Since they are pre-filled, the surgeon may have to make a larger incision to insert it. The recently FDA-approved "Gummy bear" implants by Sientra contain thicker silicone which greatly reduces the risk of rupture. These implants are available for women age 22 and older.
    • Saline: Saline implants are filled with saline, usually at the time of surgery. Saline implants have been criticized for feeling hard or unnatural, but improved surgical techniques such as placing the implant behind the chest muscle and slightly overfilling it have lessened these complaints. Saline breast implants are available to women age 18 and older.

    Good news for those who have already had surgery

    The good news for women who have had breast surgery is that as time passes, your body can naturally heal itself from nerve and tissue damage through recanalization and reinnervation.
    • Recanalization: Previously severed ducts can actually reconnect or can connect new ductal pathways in response to lactation demand through a process called recanalization. Any amount of lactation will prompt the mammary system to reestablish new ducts. Therefore, even if you cannot produce a full milk supply, it is best to continue to breast-feed and supplement because the breasts can self-repair and possibly provide a higher milk supply in the future. In some mothers, recanalization has resulted in a complete milk supply for subsequent children. Lactation tissue is also formed in response to hormones that occur during menstruation. Therefore, the longer the mother has lactated and the more menstrual cycles she has experienced, the greater the extent of recanalization.
    • "In some mothers,

      recanalization has resulted in a complete milk supply for subsequent children."

    • Reinnervation: Damaged nerves can naturally regenerate at a rate of one millimeter per month. In particular, when the nerves in the nipple-areolar complex regenerate, mothers produce a much greater supply of milk. This process is not influenced by breast-feeding, but simply occurs over time. When a woman's nipples regain normal response to touch and temperature, this indicates that the nerve infrastructure is functioning well and can send the appropriate sensations to the pituitary gland in order to produce the hormones prolactin and oxytocin, which are critical for lactation. Of course, the ability of the mammary system to fulfill the demand depends on the condition of the glands and ducts. Nonetheless, the more time that has passed since the surgery, the greater the chances that the nerves essential to supplying milk will have regenerated.

    Is breast-feeding impossible post-surgery?

    A percentage of all mothers have problems breast-feeding whether or not they have had breast surgery. Surgery will not prevent lactation, but it may alter the amount of milk a mother will be able to produce.

    There are two types of lactation failure: primary and secondary. Secondary failure, which affects 11% of women, means their milk supply has decreased due to insufficient nutrition, poor milk supply management or problems with the child's sucking – all of which have potential solutions. Four percent of women have primary lactation failure which means that their milk supply is simply not enough and there is no way to help increase it. This can be associated with glandular tissue problems, breast shape, Sheehan's syndrome or prior breast surgery.

    But even for those in the four percent statistic, some breast milk is better than no breast milk. Even if the woman cannot exclusively breast-feed, she can still supplement. Regardless of how difficult breast-feeding is physically, the success rate of breast-feeding depends largely on support.

    Certain factors can influence breast-feeding success post-surgery
    • How well the lactation glands functioned before surgery - Without adequate glandular tissue, full milk production may not be possible. In such cases, it is not the implants causing the problem, but rather the lack of glandular tissue. Certain breast types are known to be markers for insufficient glandular tissue. These include tubular-shaped breasts, widely spaced breasts, undeveloped breasts, and asymmetrical breasts.
    • The postoperative course – Follow your plastic surgeon's specific instructions for medications and vitamins to take after the surgery as well as when to resume normal activities.
    • The length of time between the surgery and lactation – As stated previously, time can significantly repair the damage done by surgery through recanalization and reinnervation. The more time between surgery and breast-feeding, the better.
    • Breast-feeding management – If breast-feeding is painful or difficult, you could be doing it incorrectly. Contact a local lactation consultant who may be able to help.
    • The mother's attitude toward breast-feeding – If a mother is embarrassed by breast-feeding or lacks emotional support, she is statistically unlikely to continue to breast-feed.

    If you are considering breast augmentation, it is best to find a physician near you and book a consultation. A board-certified plastic surgeon can answer your questions and give you guidance based on your unique needs.


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