Breast Implants and Breastfeeding

CQ #110 – September 17, 2018

by Anne Eglash MD, IBCLC, FABM

#LACTFACT

Breast implants do not have a major impact on breastfeeding success, whether they are silicone or saline. Placing the implants behind the pectoralis muscles decreases the risk of low milk supply.

Lactation Outcomes in More Than 3500 Women Following Primary Augmentation: 5-Year Data From the Breast Implant Follow-Up Study

Aesthetic Surgery Journal, Published: 27 August 2018

Do breast implants have an impact on breastfeeding?

A large 10-year observational study followed 29,000 women who received the brand Natrelle silicone breast implant and 13,700 women who received the Natrelle saline implant. Of these women, 4679 gave birth to a child after having breast augmentation, and 79.4% reported breastfeeding.

Using an annual survey, the women were asked various questions about their health, including pregnancy and lactation outcomes.

What do you think are true statements regarding breastfeeding outcomes among women with saline or silicone breast implants? Choose 1 or more:

The rate of breastfeeding complications was similar between the silicone and saline groups.
The main breastfeeding complication was recurrent mastitis because of pressure applied to the glandular tissue from the implants.
The rate of low milk supply at 18-20% was not different from other studies of breastfeeding mothers.
Placing the implant between the breast tissue and chest muscle caused more problems with milk supply as compared to placing the implant behind the chest muscle.
An incision in the underarm region (axilla) has the highest risk of low milk supply.

See the Answer

Correct Answers: A, C, and D (Not B or E)

Lactation Outcomes in More Than 3500 Women Following Primary Augmentation: 5-Year Data From the Breast Implant Follow-Up Study

Aesthetic Surgery Journal, Published: 27 August 2018

Mark L Jewell, MD, Michael C Edwards, MD, FACS Diane K Murphy, MBA Andrew Schumacher, PhD

Abstract

Background:

Women with breast implants may have concerns about their ability to successfully breast-feed. The Breast Implant Follow-up Study (BIFS-001) is a large, 10-year observational study evaluating the performance and safety of Natrelle round silicone gel-filled breast implants.

Objectives:

This analysis compared lactation outcomes in women enrolled in BIFS-001 who gave birth after they underwent primary augmentation with Natrelle round silicone implants or saline implants.

Methods:

At baseline and annually after surgery (>5-year visit window), patients completed questionnaires regarding pregnancy and lactation. Comparisons were made using summary statistics and odds ratios with 90% confidence intervals (OR [90% CI]).

Results:

A total of 4679 subjects gave birth at least once after primary augmentation for a total of 5736 live births during the study (silicone, 3695 births; saline, 2041 births). Of these, 3715 (79.4%) women breast-fed at least 1 child, resulting in 80.0% (silicone) and 75.9% (saline) of babies being breast-fed. The most common complication was insufficient milk production, which was reported for 19.6% (silicone) and 19.8% (saline) of single births (OR, 0.94 [0.83, 1.06]). Complications occurred at similar rates in each group when evaluated by incision type, implant size, pocket location, and age.

Conclusions:

In this large group of women who gave birth after primary breast augmentation with Natrelle round silicone implants or saline implants, most were able to breast-feed their infants without complications. Lactation complications were comparable between the silicone and saline cohorts, and the incidence was comparable to reports in the general population of women who breast-feed.

IABLE Comment by Anne Eglash MD, IBCLC, FABM

This is a large study identifying that women generally do well with breast implants. For those of us who care for breastfeeding dyads, this is not a surprise. The most common complication of breast implants is low milk supply, as 18-20% of mothers in this study reported. We know that low milk supply can be caused by many complications that can be prenatal, intrapartum, or postpartum in nature, and the authors point out that this rate is not much different from the rate of low milk supply in several other studies unrelated to augmentation. This group probably has a higher risk of insufficient glandular tissue as compared to the general population, although this is hard to prove.

They did find a non-significant increase in complaints of low milk supply among mothers who had larger implants (>400ml) placed as compared to those with smaller implants (<400ml). Placing the implants behind the pectoralis muscles was associated with less effect on milk supply, likely due to minimizing glandular tissue disruption.

An incision under the breast, where the breast meets the chest wall (inframammary) appeared to be the safest in terms of its impact on milk supply. An incision done to provide a breast lift in addition to implant placement (augmentation mastopexy) was most likely to interrupt the milk supply.

Patrice DeMarco

September 19, 2018 at 12:10 PM

Thank you so much for these questions and updates in the literature! I promise, I will make a donation soon.
I guess I had not read that 18-20% of BF women report low milk supply; this seems so high and hard to distinguish between actual vs perceived low milk supply for women who had this surgery vs women who did not ( could see that “reported” low milk supply stats could be the same, since so many women think they have LMS, but is it more “actual” for the surgery population?).
Also, your comment about why these women had surgery – did they have it because of breast anatomy that might indicate insufficient glandular tissue or not.

MilkMob

September 19, 2018 at 1:53 PM

The authors refer to data from the Infant Feeding Practices II Survey 2005-2005 data that showed 18-20% of mothers complained of low milk supply. You and I, as well as many others, know that low milk supply has a wide range of causes and oftentimes is just perceived. For what it is worth, this group of mothers with implants had the frequency of low milk supply complaints as a random sampling of breastfeeding mothers.

Sabine Kussmann

September 25, 2018 at 2:32 AM

Can I reshare this Lactfact and article on my FB page? (I’ll make sure to include the credit for Dr. Eglash).

September 27, 2018 at 1:48 AM

Absolutely!