With the growing number of breast augmentation procedures each year, more and more women are seeking information about breastfeeding with implants. Internet searches can be confusing. On one website various plastic surgeons assert that in most cases breastfeeding with implants offers no risk at all to a mother’s milk supply. Other sites mention potential problems of insufficient milk depending on the procedure used—while breastfeeding authors Wambach and Riordan1 refer to several studies that found only a third of mothers with implants were successful with breastfeeding. This article looks at whether breastfeeding with implants is possible, how breast implants affect milk supply and whether breastfeeding with implants is safe for the breastfed baby.
Can you breastfeed with implants?
Yes, it is possible to breastfeed with implants but breast implants can affect a mother’s capacity to produce a full milk supply. Whether a mother will have a full or only a partial milk supply depends on;
- the type of surgery involved and the amount of damage to nerves or breast tissue
- whether there is any scarring in the milk ducts, and
- how much functional milk-making (glandular) tissue is present both before and after the procedure.
As with every breastfeeding experience, success also depends on having the correct information about good latch, positioning and breastfeeding management. Knowing how to make more breast milk and wanting to succeed are also important.
all women who have had augmentation surgery face the possibility of compromising maximum milk volume not only from the site of the incision but also from nerve disruption and pressure from the implant on breast structures
How do breast implants affect breastfeeding?
Breast implants can reduce a mother’s milk supply. The extent of damage depends on;
#1 Location of the incision
The position of the cut (incision) and the surgical technique used to insert an implant affect how much damage there is to nerves, milk glands, ducts or the blood supply in the breast. For example, an incision around the edge of the areola (the darker skin around the nipple) is more likely to damage the nerve that is critical to nipple sensitivity and breastfeeding.
- Nerves. The 4th intercostal nerve is the main nerve providing sensation to the nipple and areola2. Stimulation of this nerve also triggers the release of the breastfeeding hormones oxytocin (for milk release or “let-down”) and prolactin (for milk production) from the brain3. Damage to this nerve therefore affects the reflex needed for making and releasing breast milk, and makes it difficult for a mother to know whether breastfeeding feels comfortable.
- Milk glands or ducts. Milk making or glandular tissue is found within the breast, and ducts (tubes) carry milk to the nipple. Anything that cuts across or damages the ducts or glands can interrupt the exit route for milk via the nipple or the capacity of the breast to make a full milk supply. There is a greater likelihood of damaged tissues where a breast is being remodelled (a breast lift) alongside augmentation.
There are a number of different surgical techniques to insert an implant. Five commonly described incision techniques are the inframammary, axillary, periareolar, periumbilical and transabdominal techniques. The inframammary and axillary techniques are thought to have less impact on milk production. Each of the techniques is briefly explained below:
- Inframammary technique is currently the most popular technique for breast enlargement. The incision is made under the breast and the implant is placed under the breast tissue or muscle. The scar may not be visible if it is in the inframammary crease (where the breast meets the chest wall). This technique leaves the glandular tissue and nerves intact so has less impact on milk production.
- Axillary enlargement or transaxillary technique involves inserting the implant under the muscle via an incision under the arm near the arm pit. Saline implants tend to be favoured under the muscle (Wambach and Riordan, 2015). Scarring is generally invisible and, as above, the technique leaves the glandular tissue and nerves intact.
- Periareolar incision technique involves cutting around the nipple and areola sufficiently deeply to insert the implant packet. Cutting around the areolar minimises scarring but these incisions are associated with reduced nipple stimulation and difficulties breastfeeding4. One study showed that women with this type of procedure were nearly five times more likely to have problems with breastfeeding due to damage to ducts, glandular tissue and nerves5.
- Transumbilical breast augmentation (TUBA) or periumbilical (superior) umbilical incisions involves inserting the implant via an incision in the tummy button and bringing it into place in the breast above the muscle. This technique is infrequently used and is for saline implants only (Wambach and Riordan, 2015). Positioning the implant may cause some damage to the breast tissue en route despite there not being any incisions to the breast tissue and nerves.
- Transabdominal breast augmentation (TABA) may be used for smaller implants (Wambach and Riordan, 2015)
#2 Position and size of the implant
In addition to the surgical technique (#1) the size and position of the implant can affect the pressure within the breast. The breast is composed of glandular (milk-making) tissue above a layer of muscle. If the implant packet is placed between the glandular tissue and the muscle layer, it is said to be more likely to exert pressure on the ducts and glands which may interfere with milk flow and reduce milk production. Conversely, when the implant is placed beneath the muscle layer this is said to have less impact on milk production 6. I have not yet found any reliable research studies discussing this assertion. Wambach and Riordan simply state that the implant under the muscle allows better mammography visualisation. One study found that larger implants were associated with less nipple sensitivity after surgery7.
#3 Scar tissue and engorgement
Scar tissue as a result of the surgery may cause firmness in the breast, distortion and pain and can extend into milk ducts and affect the milk supply 8. If milk can’t drain freely from the breast, women with breast implants may be more prone to excessive engorgement and mastitis 9.
#4 Changes to sensitivity
Following breast implant surgery some mothers find their breasts are very painful and incredibly sensitive even to normal touch making breastfeeding extremely difficult. Others may have a loss of feeling or numbness in the nipple due to damaged nerves. This can affect the reflex needed for milk production and make it difficult to know when a baby’s attachment at the breast (latch) feels comfortable.
#5 Functional breast tissue
Where cosmetic or reconstructive surgery to enlarge a breast is due to abnormal breast development, there may be an underlying absence of functional breast tissue. In such a situation breastfeeding difficulties could be related to this rather than the breast implant surgery directly, but problems are likely to be compounded by implants10. Diana West discusses the breast types that are risk factors for low milk production:
Although small breast size alone is not a risk factor for low milk production, certain breast types are known to be risk factors for insufficient glandular tissue. These types include tubular-shaped breasts, widely spaced breasts (greater than 1.5 inches of flat space between them), undeveloped breasts, and asymmetrical breasts. When little glandular tissue exists to begin with, milk production capability is significantly reduced even before the surgical procedures occur.
Breast implants are not lifetime devices, and often require corrective procedures11. Complications and follow up surgery for repair or revision can cause further damage to breast tissue which can affect breastfeeding success12. Complications can include long-term pain, hardening of the breast around the implant (capsular contracture), surgical removal of scar tissue, change of implant type, location or size, repeat breast uplift procedure, pressure within the breast and infection (Michalopous, 2007; Spear et al, 2003)
Random milk production
Occasionally a mother with breast implants may have milk production unrelated to breastfeeding (galactorrhea) or a milk filled cyst (galactocele)13. This is usually linked to postoperative congestion around the implant which often requires removal of the implants14. Wambach and Riordan note that spontaneous milk production, milk cysts, and extreme engorgement can follow breast surgery without a pregnancy when associated with birth control hormones15.
Can damaged glands, ducts and nerves heal?
Yes, there is potential for some glands and ducts to reconnect after surgery (recanalisation) and some damaged nerves may repair themselves over time (reinnervation). How much feeling a mother has in her breasts and nipples gives a guide to whether the nerves are intact. 16
Glandular tissue itself also continues to develop under the influence of pregnancy and breastfeeding hormones17 and areas of the breast that are functioning normally may help compensate for any damaged areas. While a mother might only produce a partial milk supply for her first baby after implant surgery, subsequent babies may enjoy an improved supply. Diana West IBCLC states that the milk supply is usually better if five years have passed since the surgery (West, 2011).
Maximising milk supply
If you are breastfeeding with implants it is helpful to stay in close contact with an IBCLC lactation consultant to maximise your milk supply. You can also read our articles on getting breastfeeding off to a good start, increasing milk supply and the value of galactagogues (herbs, foods or medications that may promote milk production).
Many mothers who have had breast augmentation or reduction surgery also increase their milk supplies with herbal and prescription galactagogues (milk-inducing substances). The herb goat’s rue in particular seems to be helpful for mothers who have had breast surgery, but there are many others that can be effective as well.
Breastfeeding with implants—safety issues
What are implants made of?
Most breast implants comprise a silicone shell filled with saline (salt water) or silicone gel (made from silicon). In 2015, Wambach and Riordan estimated that 60% of implants were filled with silicone gel. Silicone is a synthetic substance, a mixture of compounds made from silicon (a naturally occurring element found in sand). In manufacturing, silicone is generally described as having low toxicity and has various uses in industry (insulation sealants), in the medical field (tubing), and in the home (kitchenware, bottle teats, toys). Within the human breast itself however, silicone has been associated with many health issues 18.
Risks and complications of breast implants
The general safety of breast implants is beyond the scope of this article but for further information see:
- Breast Enlargement (Implants) from United Kingdom’s National Health Service discusses what could go wrong with an implant operation and see Risks and Complications of Breast Implants from the U.S. Food and Drug Administration (FDA)
- Breast Implants and Anaplastic Large Cell Lymphoma (ALCL) (UK government) and Questions and Answers About Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) (FDA)
- PIP breast implants were withdrawn from UK in 2010 and gov.uk has updates on Silimed breast implants. PIPA is a support website for PIP breast implant victims.
- What You Need to Know About Breast Implants, by the National Center for Health Research discusses the history and risks of the breast implant industry
- Support websites e.g. Healing Breast Implant Illness and Breast Implant Illness— offer support and information to those experiencing symptoms of “breast implant illness” which includes autoimmune disease, cancer and more.
- Silicone Breast Implants and Injections discusses how silicone devices within the body can cause local inflammation and autoimmune type symptoms. It questions whether silicone could be introduced to the foetus via the placenta.
Is breastfeeding with implants safe?
The safety of breastfeeding with implants is unclear:
- Conflicting information. The UK’s NHS states a baby will not be harmed by breastfeeding with implants21 and in the USA, the Centers for Disease Control and Prevention states that there is insufficient evidence to say breast implants can harm a breastfed baby22. Conversely one support group has collected studies, mostly from 1990s, that indicated possible harm for some children born or breastfed by mothers with implants23. Thomas Hale, breastfeeding and medications expert, says silicone is inert (chemically inactive) and unlikely to be absorbed in the gastrointestinal tract by a breastfed baby although he cautions good studies are lacking24.
- Gaps in knowledge. Some researchers have found that when silicone devices are inside the body they have the potential to trigger inflammation and health issues 252627. How this could affect a foetus or breastfed infant is not clear and more long-term studies are needed.
- Future research. Song et al plan to do a systematic review and meta-analysis on the health of babies born to mothers with breast implants 28.
Can breast implants leak into breast milk?
The Food and Drug Administration of the United States say it is not known whether small amounts of silicone from breast implants can enter breast milk:
At this time, it is not known if a small amount of silicone may pass through from the breast implant silicone shell into breast milk during breastfeeding. Although there are currently no established methods for accurately detecting silicone levels in breast milk, a study measuring silicon (one component in silicone) levels did not indicate higher levels in breast milk from women with silicone gel-filled implants when compared to women without implants.
The “study” often cited by Semple et al 29 is from over 20 years ago and was published in a plastic and reconstructive surgery journal (so potentially biased). It found similar levels of silicon in breast milk and blood from mothers with implants compared with mothers without implants. They also found ten times more silicon in cows’ milk and significantly higher levels in formula. However, silicon is not the same as silicone—it is an ingredient in silicone and the study didn’t look at the other potential toxic contaminants that are in implants. A study by Lykissa and Maharaj 30 found higher levels of platinum in mothers’ milk in mothers with implants than in the general population.
Hyaluronic acid injections
Core Curriculum for Lactation Consultant Practice, 2013 says that hyaluronic acid injections (Macrolane) directly into breast tissue, have been used to increase breast size since 2008. Regarding their safety with respect to breastfeeding they state:
Hyaluronic acid injections are not a contraindication to breastfeeding. The oral bioavailability of hyaluronic acid is nil and therefore even if it were to transfer into milk, it would not be readily absorbed by the baby’s GI tract (Hale, 2010; infantrisk.com, March 2011)
Breast implants have the potential to compress milk ducts and affect milk flow which can reduce a milk supply. The surgical technique used during the procedure and how much functional glandular tissue was present prior to the surgery will also dictate exactly how milk supply is affected. With these potential difficulties in mind, a mother breastfeeding with implants should take extra care to get breastfeeding off to a good start so she can maximise her milk supply. An IBCLC lactation consultant is a helpful partner to have especially if there are any early signs that baby is not getting enough milk or not gaining weight normally. It is not known whether silicone from the breast implant packet can enter breast milk. Until research proves otherwise, babies are still thought to benefit from any amount of human milk that can be provided. Currently there is no clear evidence that breastfeeding with implants could harm the baby directly other than by reducing milk available but more long-term studies are needed.
Given the risks of complications, women would be wise to delay implants until after they have their children and are no longer breastfeeding.