Breast feeding post

Breast feeding and Breast surgery

Written by: Dr Magnus Potgieter – Plastic Surgeon

Cosmetic breast surgeries are very common: with 477 347 cosmetic breast surgeries performed in the USA in 2019 (before the pandemic caused some changes).  (American Society of Plastic Surgeons website). Having children is also common (85% of all women in the USA, www.statista.com). The question whether breastfeeding would be possible after these surgeries are therefore very relevant in many households. The answer is more complex than just “yes” or “no” however, and we will explore some of these complexities here.

Before we get to the topic of how breast surgery influences breastfeeding, there are a few issues to point out without which the discussion will not be sensible.

  • The dictum “breast is best” is commonly touted in health clinics and it is difficult to disagree with that. Some components of breast milk such as immunoglobulins are not replaceable by formula. However, in cases where breastfeeding is not available, modern formula feeds are the best alternatives we have and there is no shame in using them. Also keep in mind that this is not an “all or nothing” decision and if breast milk is available, but insufficient, combination feeding can be done.
  • There are medications that can increase milk flow such as dromperidone and metoclopramide ,under certain circumstances, and under guidance of your doctor.
  • Lactation is a complex process involving many factors including psychological, hormonal, neurological and practical aspects. The reason a woman struggles to breastfeed after cosmetic surgery may be completely unrelated to the surgery but may be attributable to other problems such as poor latching, pain, infection, postpartum depression and gastrointestinal disorders of the neonate. This is best discussed with your midwife, obstetrician and paediatrician. 

That being said, there is some evidence that cosmetic breast surgery can indeed influence your ability to breastfeed. That would also depend on the type of surgery you have had. Of course, it is not possible to discuss this for each of the many different cosmetic procedures but we shall focus on the two most common: breast reduction and breast augmentation.

Breast augmentation surgery

 In breast augmentation surgery the implant is placed either on top of or under the pectoralis major muscle. Neither of these two procedures directly disrupts interrupts any milk ducts or glands, although it places them under some tension. So can you breast feed after breast augmentation? The answer is unknown and complex but the answer is “probably yes”. Two of the largest studies were done in

  1. Israel with 14 919 participants. 70.7 % participants with implants breastfed the babies while 85.1% of those without implants did. (Shai Ram , Hila Shalev Ram , Yael Shalev Rosenthal , Emmanuel Attali , Miriam Warshaviak ,Ronni Gamzu , Yariv Yogev , Gabriel Chodick) European Journal of Obstetrics & Gynecology and Reproductive Biology 268 (2022)
  2. In Australia with 378 389 participants. (An astounding number for medical research). 89% non-augmented patients breastfed while only 79% of those with implants did. (Roberts CL, Ampt AJ, Algert CS, Sywak MS, Chen JS. Med J Aust. 2015)

Both of these studies found the same thing: women who had a breast augmentation breastfed less than those who have not. However, it is unclear how many COULD not breastfeed and WHY, for example physiological or psychological reasons. The definition of successful breast feeding is also not clarified. From the Australian study we know that there are numerous other factors influencing breastfeeding.. Many of these very same factors also influence who would get a breast augmentation in the first place, for example financial means and religious convictions.  

  • Religion: more religious women tend to breastfeed more
  • Socio-economic status: middle class societies breastfeed less than very poor or very affluent communities

Breast reduction

Almost half a million breast reductions are done annually world-wide. In contrast to breast augmentation discussed above, breast reduction surgery does remove, in varying amounts, breast tissue in addition to fat. This means that both milk glands and milk ducts are lost. Whether an individual woman would be able to breastfeed or not has to be seen by attempting it.  So, once again, on the question of whether you can breastfeed after a breast reduction, the answer is “likely, yes” but the answer is complex and unique to the individual, and even more variable than for breast augmentation.  It is simply an impossible question to give a simple answer to. Even the studies that have been done vary widely just in their definition of breastfeeding success (With anything from a single attempt being “successful” to 24 weeks of exclusive breastfeeding meaning success.)

In addition to all the varying factors influencing breastfeeding as discussed above, the amount of breast tissue removed and the technique used would also influence the effort. The technique used by the surgeon varies widely and is dependent inter alia on the patient’s breast size, breast tissue density, tissue/ skin quality, previous breast surgery and breast disease such as the location of cysts or benign tumours. The surgeons training in a specific technique often also varies widely among institutions and even countries.

A Canadian study (Kraut RY, Brown E, Korownyk C, Katz LS,Vandermeer B, Babenko O, et al. (2017) The impact of breast reduction surgery on breastfeeding: Systematic review of observational studies.) divided their participants into three groups, with varying amounts of tissue preservation and found that in maximum tissue preservation techniques up to 100% of women could breastfeed when they tried. This dropped to 4% of women where more aggressive techniques are used (those for example with larger breasts, needing more tissue removal or breast amputation). I need to emphasize again, as above, that the technique used depends on many factors and that specific techniques cannot be requested based on the above statistics. The aim, after all, of a breast reduction, is to remove breast tissue of varying amounts to alleviate back pain and improve cosmesis. However: In the most commonly used techniques, for the average reduction, a fair amounts of breast tissue is spared and it should follow that in most cases breast feeding will be possible afterwards.

If future breastfeeding is a concern for you, this needs to be discussed with your plastic surgeon. He or she will clearly not be able to give you any guarantees either way, but can discuss some probabilities with you depending on your unique circumstances. He/She may also tell you to consider postponing the reduction until after pregnancy/lactation, in order to maximize chances of breastfeeding. It’s a decision every woman will need to make for herself after discussion with her surgeon. In my experience it is exceptionally rare for women to forego or even just postpone surgery for a chance that they may not be able to breastfeed. The vast majority proceed to surgery with the resolution to try to breastfeed but if there is not enough milk to supplement with formula feeds. Some cannot bear the thought of their already large breast becoming even larger during pregnancy, and of course some women may not currently be planning to have any children, but may elect to do so in future.

On the flipside

Just as surgery can influence breastfeeding, so pregnancy and breastfeeding can influence your surgical result. Breasts typically enlarge significantly during pregnancy and lactation, stretching the skin, which may not completely shrink back to its original size leaving the breasts droopy (ptotic). This may require touch up breast lift or re-reduction surgery.

Conclusion

Since breast milk is superior to formula, we need to encourage women who had breast surgery to at least TRY to breastfeed and then supplement with formula feeds as needed, as it is more likely than not that they will in fact be able to breastfeed.

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