Breast Implants While Breast Feeding

There are many patients that have undergone breast augmentation surgery by Dr. Romano and subsequently had children, breast fed, and returned back again for evaluation of the breasts. Almost any time that a woman has breast fed with implants, the tissues have stretched somewhat to the point where the breasts appear even more natural with a slope to the top and roundness to the bottom. Rarely after breast feeding with implants has a lift been needed. Occasionally an exchange for a larger implant may be requested. None of the breast enlargement procedures are known to significantly interfere with the ability to breast feed.

THE CONCERNS

Many patients prior to augmentation are concerned about three very important functions of their anatomy: sensation, the ability to breast feed, and the changes in shape after breast feeding.

 

SENSATION. It is very difficult even under the most extremes of surgical procedures to end up with totally numb nipples or breasts. This is simply due to the fact that in the normal breast there is an abundance of nerves that provide sensation to the skin and nipples. Almost certainly one or even many of these nerves are cut or stretched during the surgery. But, the fact remains, that many of these nerves heal and resume their normal, or near normal function. Also, there seems to be enough nerves still present to maintain these functions. If there is a permanent nerve change after surgery it usually involves extra sensation (hypesthesia) or some decreased sensation (hypoesthesia) but rarely complete numbness (anesthesia).

 

BREAST FEEDING. Breast feeding is a similar issue. When implants are placed, the incisions used to provide access to making a breast pocket can divide the breast tissue, the milk ducts, or the nerves that may mediate the breast feeding process and cycle of stimulation and breast milk production. Certain incisions may be more at risk than others. For example, the nipple incision may divide more breast tissue and nerves than the incisions in the armpit, belly button, or breast crease that all go below the breast tissues.

 

SHAPE. It is very difficult to predict who will have breast sagging or deflation (involution) after breast enlargement and breast feeding. I tell women that if you have the anatomy that predisposes you to stretching and sagging, you will get it after breast feeding and implants, and maybe worse. If you don’t have the anatomy prior to your surgery, you will probably not get it after breast feeding. In general, most women who desire augmentation have a smaller breast size and therefore, a smaller breast gland size. Therefore, your gland will not enlarge that much after breastfeeding, and you will likely not sag. There is no predictor of how large your gland will get while breast feeding, and no predictor of how well it will shrink when you stop breast feeding. The larger the implant, just by weight and gravity, the more likely you will sag and stretch.

THE SUGGESTIONS

• If you are concerned about sagging and involution after breast implant surgery and breast feeding, consider not breast feeding or consider a smaller implant, or realize you may need a lift later.
• If you are very concerned about breast feeding and/ or nipple sensation, consider the following:
  • Use an incision that violates the breast tissue and nerves the least such as the breast crease, armpit or belly button.
  • Determine from your surgeon if you will need any internal breast surgery and the extent. This may relate to whether your breast gland will need to be cut and shaped internally. This is often seen, for example, in patients with tubular breast anatomy, or a constricted, tight breast.
  • Understand that the smaller your breast, and the larger the implant you desire, the more stress that will be placed on the nerves and breast gland that are stretched out in the manner.
  • Careful and delicate handling of the tissues at the time of surgery with minimal disturbance of the nerves and breast gland are always our surgical goals.
  • Capsular contracture can constrict the breast implant, distort nerves and cause pain.
  • Revision surgeries can each time increase the likelihood of more nerve injury and less ability to breast feed.

THE CONCLUSIONS

• If you are very concerned about breast feeding and sensation, there are some things for you and your surgeon to consider as noted above.
• It is rare to end up with completely numb nipples and breasts.
• Most of the time breast feeding will still be possible regardless of the procedure. You may produce less milk depending on some of the above noted factors.
• If you have sagging or loose skin before surgery, you will likely sag or deflate after breast implants and breast feeding, but this is not always true.
• If you have small breasts and firm skin prior to surgery, you will likely not sag or deflate and look mostly normal after breast feeding, but this is not always true.

For before and after images of this procedure click here

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