Breast Surgery Likely to Cause Breastfeeding Problems

By Patricia Lieberman, Ph.D., Padma Ravichandran

Updated April 2010

According to the Institute of Medicine (IOM), any kind of breast surgery, including breast implant surgery, makes it at least three times more likely that a woman trying to breastfeed will have an inadequate milk supply (lactation insufficiency).1 The IOM based that conclusion on a number of studies of women with breast implants or other breast surgery. A description of those studies follows.

In a study conducted by Dr. Marianne Neifert and colleagues at the University of Colorado School of Medicine, women who had breast surgery were three times more likely to have lactation insufficiency than those that did not have breast surgery.2 The doctors compared the rate of weight gain of breastfed infants born to mothers who either did or did not have previous breast surgery. Mothers whose babies did not gain at least one ounce per day, or who required supplemental feedings with formula, were deemed to have lactation insufficiency. Interestingly, the women who had breast surgery through an incision in the nipple area (periareolar incision) had even higher rates of problems. Those women were five times more likely to have insufficient milk compared to women without breast surgery.3

 

Breast Implants Can Cause Breastfeeding Problems

In a study by Nancy Hurst, RN, MSN, from Texas Children’s Hospital, 64% of women with breast implants had lactation insufficiency, compared to 7% of women without implants.4 Periareolar incision was most likely to cause a problem, but other incisions also made it significantly more difficult for women to nurse.

A study by Dr. Sara Strom and others at the University of Texas M.D. Anderson Cancer Center looked at nursing rates among 46 new mothers who had previously received saline-filled breast implants.5 Of those women, 28 chose to breastfeed their baby, but 11 (39%) had problems breastfeeding. Eight of those 11 had problems that they attributed to their breast implant. Seven out of eight of those women received their implant through a periareolar incision. Although this study did not have a group of non-implanted women to serve as a control, it is consistent with other studies that show that women with implants have a high rate of problems breastfeeding.

Having breast implants also can deter women from attempting to breastfeed, according to Strom’s study. When asked about the main reason that they didn’t attempt to breastfeed their babies, implanted women who chose not to breastfeed said they feared lactation insufficiency and other complications due to the implants. Another study by Cruz and Korchin found that women with breast implants were less likely to breast feed due to breast pain, capsular contracture, and pressure on the breast from the implant.12

 

Complications From Surgery

It is not completely clear why breast implants cause problems with breastfeeding. One possibility is that the surgery may damage the milk-producing ducts. That is especially likely if the implants are inserted through a periareolar incision. Another possibility is that the breast implant may be putting pressure on the breast tissue, which could damage the breast tissue, and thereby diminish milk production.

Another possible explanation is that nerves are injured, causing loss of nipple sensation. When a woman loses nipple sensation she also loses the suckling reflex that is essential to breast feeding. The suckling reflex initiates the nervous system, which then sends a signal to the pituitary gland to produce the hormones prolactin and oxytocin. The prolactin is necessary for milk production and the oxytocin is necessary for milk “let-down.” Without the suckling reflex and resulting hormone release, it is not possible to breastfeed.13

At this point it is impossible to determine whether the breastfeeding problems that implanted women have are due to the implant or the surgery. Either way, the end result is the same – women who have breast implants, especially if they have an incision around the nipple, are less likely to be able to breastfeed. Cruz and Korchin found that women with saline-filled implants were 25% less successful at breastfeeding and 19% more likely to supplement their breastfeeding than women who did not have breast implant surgery.14

 

Lack of Research for Common Problems

In addition to the above problems which were revealed in empirical studies, there have been a number of case reports of women with breast implants being unable to breastfeed pre-term babies or having abnormal lactation or other breast problems after full term babies, such as mastitis (infection of the breast, which is usually caused by a bacterial infection), galactorrhea (breast milk production by a woman who is not pregnant and has not just given birth), or galactocele (a milk-filled tumor in a blocked breast milk duct) formation. 6,7,8,9,10,11,15 It is impossible to determine how often those complications occur after breast implants, because there has never been a research study.

There is consensus in the medical and public health community that breast milk provides essential nutrition for babies, in addition to improving their immune responses to infections. Breastfed babies have been shown to be less likely to have gastrointestinal disease, respiratory ailments and asthma, ear infections, and allergies. Some researchers believe that breastfeeding provides protection against obesity, arteriosclerosis, celiac disease, and other metabolic disorders. Other studies have shown that breastfeeding is beneficial to the mother as well, helping to create a psychological bond between mother and infant, aiding postpartum recovery, and helping mothers to more quickly return to their pre-pregnancy weight. It is therefore of considerable concern that breast implants – or the surgery to get them – may make it more difficult for women to breastfeed successfully.

References:

1 National Academy of Sciences Institute of Medicine, Safety of Silicone Breast Implants, National Academy Press, Washington, D.C., 1999, p. 197.

2 Neifert, M., DeMarzo, S., Seacat, J., Young, D., Leff, M., Orleans, M., The Influence of Breast Surgery, Breast Appearance, and Pregnancy-Induced Breast Changes on Lactation Sufficiency as Measured by Infant Weight Gain, Birth, 1990; 17: 31-38.

3 Of the 22 women who had breast surgery, only five had breast augmentation with breast implants.

4 Hurst, N.M., Lactation After Augmentation Mammoplasty, Obstetrics & Gynecology, 1996; 87: 30-34.

5 Strom, S.S., Baldwin, B.J., Sigurdson, A.J., Schusterman, M.A., Cosmetic Saline Breast Implants: A Survey of Satisfaction, Breast-Feeding Experience, Cancer Screening, and Health, Plastic and Reconstructive Surgery, 1997; 100: 1553-1557.

6 Deloach, E.D., Lord, S.A., Ruf, L.E., Unilateral Galactocele Following Augmentation Mammoplasty, Annals of Plastic Surgery, 1994; 33: 68-71.

7 Hartley, J.H., Schatten, W.E., Postoperative Complications of Lactation after Augmentation Mammaplasty, Plastic and Reconstructive Surgery, 1971; 47: 150-153.

8 Johnson, P.E., Hanson, K.D., Acute Puerperal Mastitis in the Augmented Breast, Plastic and Reconstructive Surgery, 1996; 98: 723-725.

9 Luhan, J.E., Giant Galactoceles, One Month after Bilateral Augmentation Mammoplasty, Abdominoplasty, and Tubal Ligation: Case Study, Aesthetic Plastic Surgery, 1979; 3: 161-164.

10 Mason, T.C., Hyperprolactinemia and Galactorrhea Associated with Mammary Prostheses and Unresponsive to Bromocriptine: A Case Report, Journal of Reproductive Medicine, 1991; 36: 541-2.

11 Menendez-Graino, F., Pena Fernandez, C., Burrieza, P.I., Galactorrhea after Reduction Mammaplasty, Plastic and Reconstructive Surgery, 1990; 85: 645-646.

12  Cruz, N.I., Korchin, L. (2010). Breastfeeding after augmentation mammoplasty with saline implants. Annals of Plastic Surgery. 64(5). 1-4.

13  Cruz, N.I., Korchin, L. (2010). Breastfeeding after augmentation mammoplasty with saline implants. Annals of Plastic Surgery. 64(5). 1-4.

14 Cruz, N.I., Korchin, L. (2010). Breastfeeding after augmentation mammoplasty with saline implants. Annals of Plastic Surgery. 64(5). 1-4.

15 Hill, P.D., Wilhelm, P.A., Aldag, J.C., Chatterton, R.T. (2004). Breast augmentation and lactation outcome: A case report. MCN. The American Journal of Maternal and Child Nursing. 29(4). 238-242.