Breast Feeding & Implants

I wrote this section for the website to address a very common, and very good, question that women have; “What happens to my breasts with implants after breast feeding?” The real answer is that no one knows, and your breasts will give us that answer. But, there are some facts I can share with you. I have operated on many women for breast augmentation that have subsequently had children, breast fed, and returned back again for evaluation of the breasts. No one has experienced any severe deformity or sagging.

Almost any time that a woman has breast fed with implants, the tissues have stretched somewhat then returned to the point where the breasts actually appear better, with a more natural slope to the top and roundness to the bottom. Rarely after breast feeding with implants has a lift been required. 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.

Many patients prior to augmentation are concerned about three very important aspects of their anatomy: sensation, the ability to breast feed, and the changes in shape after breast feeding. Let me share some facts with you here.

SENSATION. It is very difficult even under the most extreme 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 and take over the function of any injured nerves. 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 after placement of implants is a similar issue women often ask about. 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 medicate the 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. Despite all this breast feeding to some degree is virtually always possible.

 

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 whether you have implants or not. If you are in this category and have implants, then it may be even worse. If you don’t have this stretching type of anatomy prior to your surgery, you will probably not get sagging even 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 breastfeeding. The larger the implant, just by weight and gravity, the more likely you will sag and stretch.

 

I have several suggestions here which I review with all my patients. 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 divides the least amount of breast tissue and nerves. This is the incision in the breast crease.

• Determine before your surgery 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 my surgical goals.

• Capsular contracture can constrict the breast implant, distort nerves and cause pain. So, consider doing a lot to prevent this.

• Revision surgeries can each time increase the likelihood of more nerve injury and less ability to breast feed.

In conclusion, I would say that if you are very concerned about breast feeding and sensation, there are some things for you and me 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. Even if you sag some, most of the time it looks fine and does not require lifting. 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.

For before and after images of this procedure click here

Please call or contact the office for any further information or to schedule an appointment.