Breast augmentation surgery

How do implants affect breastfeeding?

Women with implants may feel more breast pain when the milk comes in, and the breast and nipple root can become firm, leading to latching pain or even latching problems. Implant surgery may leave women with sensitive nipples and areolas. Other mothers with implants have less sensation in their nipples and don’t feel the pain that would normally warn them of a problem, leading to delayed treatment for injury or infection. The lack of sensation may impair the let-down reflex, resulting in poor milk removal from the breast. Complications of breast implants can have a variable effect on breastfeeding. Silicone from the implant does not appear to enter breast milk.   

A) Describing breast augmentation surgery

In breast augmentation surgery, a silicone sac containing salt water or silicone is placed between the pectoralis muscle of the chest and the breast or under the pectoralis muscle. This surgery may impact future breastfeeding.

B) Safety of breastfeeding with breast implants

Mothers with breast implants are encouraged to breastfeed, because the benefits of breastfeeding for mother and baby outweigh the risks posed by the implant.

One study (Semple 1998) showed that milk from mothers with breast implants contained about the same amount of silicone as milk from mothers without implants and that the levels were roughly one-tenth the level found in cow’s milk and one-one-thousandth the level found in infant formula. If any silicone is absorbed by the baby, it is likely passed through the baby’s gut.

C) Effect of breast implants on breastfeeding

Breast surgery can cause a number of breastfeeding problems. The following are the most common ones following augmentation surgery.  

1) Likelihood of breastfeeding  

Some studies show that mothers with implants are less likely to breastfeed and less likely to breastfeed exclusively (Bompy 2019; Cheng 2018; Cruz 2010; Marcacine 2018; Roberts 2015; Schiff 2014). However, a large study (Jewell 2019) of 3,500 American mothers with implants found that their breastfeeding rates and complication rates were similar to those of mothers without implants.

The way the implant is inserted has been thought to affect the amount of milk a baby can get from the breast. Implants can be inserted under the breast and from the armpit or from a cut made at the edge of the areola (peri-areolar).

Some researchers have found that peri-areolar insertions can cut ducts and reduce the sensitivity of the nipple and areola, but more recent studies have not found this (Cheng 2018; Cruz 2010; Hurst 1996; Jewell 2019; Lund 2016; Neifert 1990; Strom 1997).

A woman may have breast augmentation surgery because she has small or irregularly shaped breasts due to insufficient glandular tissue (IGT) and wants her breasts to look more typical. In this case, IGT, and not the surgery, is likely the cause of a low milk supply. This may also be the case for mothers who have one breast that is much smaller than the other.

2) Pain with breastfeeding

Women who have had breast implants may feel more breast pain when the milk comes in. The implant may reduce the space in the breast that can accommodate the milk that is suddenly present, and the breast and nipple root can become excessively firm. This may create latching problems.  

Breast augmentation surgery may leave women with very sensitive nipples and areolas. Mothers with breast augmentation are more likely to have nipple pain and damage (Marcacine 2018). 

3) Decreased breast sensation

Other mothers have decreased sensation and don’t feel the pain that would normally warn them of a problem. This is dangerous, because the treatment for nipple damage or infection may be delayed.

The decreased sensation may also impair the let-down reflex and result in poor milk removal and in a decreased milk supply over time.

D) Other conditions that can affect breastfeeding after breast augmentation

Women who have breast implants can develop problems and the impact on breastfeeding can vary.

1) Implant complications

Complications from the implant include those that:

a) Develop soon after surgery:

  • Infection
  • Scarring
  • Fluid or blood around the implant
  • Breast pain
  • Poor cosmetic outcome
  • Nipple or breast sensation changes

b) Develop later:

  • Movement of the implant
  • Leaking or flattening of the implant
  • Scarring of the tissue around the implant
  • Breast cancer (anaplastic large cell lymphoma)

Correction of these may require further surgery. Ideally, this is not done while the mother is breastfeeding.

2) Effect of silicone on the body

Silicone was previously thought to be inert (Institute of Medicine 1999). There seems to be a debate over whether silicone breast implants cause diseases in which the body attacks itself (autoimmune diseases) (Coroneos 2019; Rohrich 2019).

3) Polyacrylamide hydrogel

Breast augmentation by injecting gel (polyacrylamide hydrogel) into the breast was popular in some countries in the 1980s and 1990s. It is rarely used today and many countries have banned the procedure (Margolis 2015). Women who had this procedure have developed complications such as infection, breast lumps, breast hardening, and connections between the breast tissue and skin (fistulas). The presence of the gel and the complications from this procedure and surgery needed to treat them can affect breastfeeding (Ebisudani 2021; Bourke 2018).

4) Breast cancer 

Certain type of implants (textured) have a risk, albeit low, of causing a unique type of breast cancer (anaplastic large cell lymphoma) (Leberfinger 2017; Quesada 2019). This type of cancer can declare itself when the breast suddenly becomes enlarged. Please see your health-care providers if you notice this.

References

Bompy L, Gerenton B, Cristofari S, et al. Impact on Breastfeeding According to Implant Features in Breast Augmentation: A Multicentric Retrospective Study. Ann Plast Surg. 2019;82(1):11‐14
 
Bourke AG, Jose C. Recurrent complications of PAAG implants during lactation. BMJ Case Rep. 2018 Nov 5;2018
 
Cheng F, Dai S, Wang C, et al. Do Breast Implants Influence Breastfeeding? A Meta-Analysis of Comparative Studies. J Hum Lact. 2018 Aug;34(3):424-432
 
Coroneos CJ, Selber JC, Offodile AC 2nd, et al. US FDA Breast Implant Postapproval Studies: Long-term Outcomes in 99,993 Patients. Ann Surg. 2019 Jan;269(1):30-36
 
Cruz NI, Korchin L. Breastfeeding after augmentation mammaplasty with saline implants. Ann Plast Surg. 2010 May;64(5):530-3

Ebisudani S, Inagawa K, Suzuki Y, et al. Unilateral Breast Inflation Caused by Breastfeeding after Polyacrylamide Hydrogel Injection. Plast Reconstr Surg Glob Open. 2021 Jan 14;9(1):e3335

Hurst NM. Lactation after augmentation mammoplasty. Obstet Gynecol. 1996;87(1):30-34
 
Institute of Medicine (US) Committee on the Safety of Silicone Breast Implants; Bondurant S, Ernster V, Herdman R, editors. Safety of Silicone Breast Implants. Washington (DC): National Academies Press (US); 1999
 
Jewell ML, Edwards MC, Murphy DK, et al. Lactation Outcomes in More Than 3500 Women Following Primary Augmentation: 5-Year Data From the Breast Implant Follow-Up Study. Aesthet Surg J. 2019 Jul 12;39(8):875-883

Leberfinger AN, Behar BJ, Williams NC, et al. Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Systematic Review. JAMA Surg. 2017 Dec 1;152(12):1161-1168.
 
Lund HG, Turkle J, Jewell ML, et al. Low Risk of Skin and Nipple Sensitivity and Lactation Issues After Primary Breast Augmentation with Form-Stable Silicone Implants: Follow-Up in 4927 Subjects. Aesthet Surg J. 2016;36(6):672-680
 
Marcacine KO, Abuchaim ESV, Coca KP, et al. Factors associated to breast implants and breastfeeding. Rev Esc Enferm USP. 2018 Oct 11;52:e03363
 
Margolis NE, Bassiri-Tehrani B, Chhor C, et al. Polyacrylamide gel breast augmentation: report of two cases and review of the literature. Clin Imaging. 2015 May-Jun;39(3):339-43
 
Neifert M, DeMarzo S, Seacat J, et al. The influence of breast surgery, breast appearance, and pregnancy-induced breast changes on lactation sufficiency as measured by infant weight gain. Birth. 1990 Mar;17(1):31-8
 
Quesada AE, Medeiros LJ, Clemens MW, et al. Breast implant-associated anaplastic large cell lymphoma: a review. Mod Pathol. 2019 Feb;32(2):166-188
 
Roberts CL, Ampt AJ, Algert CS, et al. Reduced breast milk feeding subsequent to cosmetic breast augmentation surgery. Med J Aust. 2015 Apr 6;202(6):324-8
 
Rohrich RJ, Kaplan J, Dayan E. 'Silicone Implant Illness': Science vs Myth? Plast Reconstr Surg. 2019 Apr 22
 
Schiff M, Algert CS, Ampt A, et al. The impact of cosmetic breast implants on breastfeeding: a systematic review and meta-analysis. Int Breastfeed J. 2014 Oct 17;9:17
 
Semple JL, Lugowski SJ, Baines CJ, et al. Breast milk contamination and silicone implants: preliminary results using silicon as a proxy measurement for silicone. Plast Reconstr Surg. 1998 Aug;102(2):528-33
 
Strom SS, Baldwin BJ, Sigurdson AJ, et al. Cosmetic saline breast implants: a survey of satisfaction, breast-feeding experience, cancer screening, and health. Plast Reconstr Surg. 1997;100(6):1553-1557