Breastfeeding After Breast Reduction or Mastopexy
by Anne Eglash MD, IBCLC, FABM
Breast reduction is a common procedure to alleviate physical and psychological discomfort related to large breasts, such as chronic neck, back and shoulder pain, headaches, and poor self-image. Mastopexy, aka breast lift, is done to improve alignment, sagging, or asymmetric breast sizes.
Although the association between breast reduction, mastopexy and low production is apparent clinically, there is insufficient research on the impact of these surgeries on milk production.
A recent study compared breastfeeding outcomes among women who had breast reduction surgery or mastopexy with those who didn’t. The study involved querying 772 patients aged 16-45 who underwent surgery between 2010-2020 in France. Out of the 209 responses received, 104 had pregnancies before surgery and 61 after.
The success rate for breastfeeding (at least 2 weeks, exclusively or mixed) was 82% in the preop group and 41% in the postop group. The type of surgery or tissue removal didn’t affect breastfeeding success. The preop group had an 80% initiation rate and 65% exclusivity rate, while the postop group had a 72% initiation rate and 28% exclusivity rate.
- 24%, 48%
- 32%, 94%
- 40%, 73%
- 48%, 69%
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Abstract
Breastfeeding has been widely encouraged by health care systems for many years. Breast reduction or mastopexy, are very frequent procedures often performed on young women. The main objective of this study is to evaluate the impact of breast surgery on breastfeeding by comparing the success rate of breastfeeding in operated women versus unoperated women. Secondary objectives are to evaluate the breastfeeding success rate according to the surgical technique or the weight resected. A retrospective comparative study was conducted. Women of childbearing age who underwent breast reduction surgery or mastopexy at Henri-Mondor Hospital were contacted to answer a questionnaire about their pregnancies. Two hundred nine patients answered and two groups of patients were constituted, a preoperative group of 104 women who had a pregnancy before surgery and a postoperative group formed by 61 women who had a pregnancy after surgery. Breastfeeding success rate was 82% in the preoperative group versus 41% in the postoperative group. A statistically significant difference was found on the success rate of breastfeeding, as well as the rate of exclusive breastfeeding, with significantly lower rates in the postoperative group. In contrast, there was no significant difference between the different pedicles used, neither according to the weight of the resected gland. The cause of failure in the postoperative group was in most cases insufficient milk. Breast reduction surgery or mastopexy seems to have negative impact on the ability of operated women to breastfeed. This impact is multifactorial so these results should be interpreted with caution and further studies are needed to improve the management of these patients.
Studies have demonstrated a link between breast reduction surgery and insufficient milk production. However, the relationship between breast reduction, mastopexy (breast lift), and milk production remains unclear due to limitations in existing research. Most, if not all, studies lack adequate measurement of lactation (2 weeks as success?!) and fail to control confounding factors. For instance, patients with bilateral breast ptosis who undergo a mastopexy may have low milk production due to underlying hypoplasia rather than solely as a result of the breast surgery itself.
Given the current state of evidence, my approach is to assume that every patient with a history of breast reduction or mastopexy is at risk for low milk production until proven otherwise. These patients require close monitoring postpartum to ensure optimal infant growth and lactation support. Further research with more rigorous methodologies is needed to better understand the impact of these surgical procedures on lactation and to guide clinical decision-making.