Breast Feeding & Implants

I wrote this section of 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 the answer. But there are some facts I can share with you. I have performed breast augmentations on many women who have subsequently had children, breast-fed, and returned back again for evaluation of their breasts. None of these women has experienced any severe deformity or sagging.

Almost any time that a woman has breast-fed with implants, the tissues have stretched somewhat and then returned to the point that the breasts actually appear better; they have a more natural slope to the top and roundness to the bottom. Rarely has a lift been required after breast-feeding with implants. Occasionally an exchange for a larger implant may be requested. None of the breast enlargement procedures is known to significantly interfere with the ability to breast-feed.

Prior to augmentation, many patients 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 about these concerns with you:

• Sensation: Even under the most extreme of surgical procedures, it is very difficult to end up with completely 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 will be 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 seem 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 that 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 mediate the breast-feeding process and the cycle of stimulation and breast milk production. Certain incisions may be more of a 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, all of which go below the breast tissues. Despite all of this, breast-feeding is virtually always possible to some degree.
• 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 breast-feeding, 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 it is that you will sag and stretch.

I have several suggestions about this, which I review with all of my patients. If you are concerned about sagging and involution after breast implant surgery and breast-feeding, consider not breast-feeding, consider a smaller implant, or realize that you may need a lift later. If you are very concerned about breast-feeding and/or nipple sensation, consider the following:

• Use the incision that divides the least amount of breast tissue and nerves: the incision in the breast crease.
• Before your surgery, determine if you will need any internal breast surgery and to what 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 will be placed on the nerves and breast gland that are stretched out.
• 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 from happening.
• Each time you undergo revision surgeries, the likelihood of more nerve injury and less ability to breast-feed increases.

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 you will most likely look normal after breast-feeding.