Women who choose to have a breast augmentation before children, tend to have concerns about their future family plans and how their choice for surgery may affect those endeavors. In our first installment, we discussed having a breast augmentation and the changes the breasts then go through when pregnant, as well as the modifications that take place post-pregnancy. Here, we'll touch on concerns women have about breastfeeding with breast implants.
Breastfeeding and Breast Implant Safety Concerns
There were once concerns about silicone leeching into breast milk. While it is possible, and perhaps even likely, silicone is widely present in the environment--it is the second most common element in the earth's crust--and avoiding ingestion is challenging. Silicone products are used in a variety of medical and non-medical devices; it is considered a medically inert substance. In fact, mothers who choose not to breastfeed may still expose their baby to silicone, for many bottle nipples, pacifiers, or teethers contain silicone.
So, whether you have saline or silicone breast implants and plan to breastfeed, your baby may ingest silicone. How is this possible with saline implants, you ask? Despite saline implants being filled with saline solution, their shell is made of silicone.
The question then becomes whether silicone is harmful to infants.
In nature, a single silicon atom is enclosed by four oxygen atoms, which helps to form a three-dimensional chain of compounds. Silica is permitted as a food additive and is well-known to cause pulmonary fibrosis should it be inhaled into the lungs. This form of silica is not used in breast implants. Instead, the compound used for most biologic implants is polydimethylsiloxane [PDMS], a silicone polymer that is insoluble in biological fluids. Straight chains of PDMS are fluids, while cross-linked chains are gels or solids. This commonly makes up the internal filler of the silicone gel implant and should it bleed through the silicone elastomer found on the outside of both saline and silicone implants, it could be devoured by the body's phagocytes and moved to areas of the body. Large amounts could cause granulomas, small areas of inflammation in tissue. But because of the widespread presence of silicon compounds in the environment, it would be unlikely that the breast implants would be the sole source of this problem.
As for a rupture occurring with a saline implant and the solution leaking into the breast milk. Again, it is possible. However, saline solution is absorbed and processed out by the body, and has been found not to be harmful.
Can You Breastfeed with Breast Implants?
Though some research suggests that women with breasts implants are more prone to have complications breastfeeding than women who have not had breast augmentation surgery at all, the odds of successfully being able to do so are still in your favor. Still, there are some factors that determine breastfeeding success.
First let’s discuss the most common methods of breast augmentation and how it relates to breastfeeding. The placement of the implant will be under the muscle, either full unders or partial unders, or it will be over the muscle. Under the muscle is most common in the United States. This placement separates the milk-producing tissue of the breasts from the implant. This reduces the risk of any breastfeeding-related infection spreading to the area around the implants. If the implants are placed over the muscle, there is still a chance the woman could go on to breastfeed with no problems.
The next point of consideration is the incision used. Transaxillary, TUBA, and inframmamory fold incisions will not have a surgical path that comes close to the milk ducts that transfer milk. There is very little risk to future breastfeeding with these incision options. An areola incision is not one that prohibits breastfeeding, but it does have an increased risk for problems. With an areola incision there may be milk ducts leading to the nipple that are severed or damaged. This still leaves the vast majority of the milk ducts undisturbed, allowing for breastfeeding. Women who have had any form of a lift will have areola incisions, so the amount their milk ducts are affected my vary dependent on the lift they had.
Problems That Could Make Breastfeeding with Implants Complicated
Nipple sensation is a large concern for any breast augmentation patient. This is an important concern for women who may breastfeed—implants or not. With a normal breast augmentation, the changes to nipple sensation are usually temporary, but, in some cases, women can experience permanent changes. Loss of sensation is a problem for several reasons. First is the reduction in sensation of the breastfeeding baby. The breast mechanics are designed in such a way that the suckling of a baby will induce the letdown reflex of the milk. Milk production is a supply and demand function. If you cannot feel your baby suckling, it may be hard to encourage your milk to letdown and for adequate milk production to continue. Nipple sensation is also very important factor in determining if your baby is latched on properly. If the breastfeeding mother cannot feel her baby’s latch, she may not notice that there is a problem until there has been damage done to the nipple. Cracked, bleeding, and painful nipples can become infected with bacterial or yeast infections, which delay healing even further. Over time, a bad latch can lead to repeated nipple injury and long-term damage. Some women may experience the exact opposite: an increase in sensation. This can make a successful breastfeeding relationship unbearable because even a good latch may become painful.
The Breast Themselves
It is important to note that while a breast augmentation will not prevent you from breastfeeding, there are conditions that may. Severely underdeveloped breasts (breast hypoplasia) may not have developed the milk glands and ducts necessary to breastfeed, or they may have partially developed milk glands and ducts. This is often the case with tuberous breast deformity. The surgery done to correct tuberous breasts often involves an incision completely around the nipple to correct its herniated appearance. This can sever or damage any milk glands that may have developed in a woman with tuberous breasts. But not all tuberous breasts are partially developed, some have a normal amount of milk ducts and glands. In either of these two cases, it is impossible for the woman to know if she can fully breastfeed or partially breastfeed until she tries. Many women connect any breastfeeding problems with their surgery but do not consider that she may have anatomical limitations to breastfeeding.
To find out how you can get your body--specifically your breasts, tummy and thighs--back to its pre-pregnancy stage, read our final installment in the Mommy Diaries Series on the Mommy Makeover.
Created October 2016