Breastfeeding After Breast Reduction or Augmentation Surgery
Published: 26 October 2021
Published: 26 October 2021
Women who have had breast surgery are naturally concerned about how the procedure might impact their ability to breastfeed.
A compassionate, well-informed approach from postnatal carers can make all the difference to the success - or failure - of breastfeeding following surgery.
Augmentation mammoplasty is a surgical procedure that increases the size of the breast by inserting implants under the breast tissue or chest muscles. According to Schiff et al. (2014), it remains one of the most common plastic surgery procedures worldwide.
It’s usually possible for mothers with breast implants to breastfeed successfully, but this can depend on many factors affecting the milk supply. For example:
Both the location and placement of the surgical incision can have a direct bearing on the mother’s ability to produce milk postnatally. For example, an incision around the areola, or across a portion of it, can reduce the nerve response needed for the let-down reflex to function properly. Equally important is the position of the implant, which may cause reduced milk production and flow if too much pressure is placed on the glandular tissue (BFAR 2016).
Additional factors that can reduce the success rate of breastfeeding with implants include:
Sadly, many women are not well-advised about potential postnatal problems surrounding breastfeeding. Yet, despite these difficulties, the glandular tissue of the breast naturally continues to develop under the influence of pregnancy and breastfeeding hormones. The remaining areas of the breast that are functioning normally can also help to compensate for damaged areas.
A study by Davanzo (2018) found that women who had undergone breast augmentation experienced no differences in attempting to breastfeed, but overall, they had a lower rate of breastfeeding at discharge and a lower rate of exclusive breastfeeding at one month postnatally.
This is why it’s so important for the maternity care team to identify women who have undergone breast augmentation surgery so that extra help and support can be given in order to establish successful feeding routines (Roberts et al. 2015).
Breast reduction surgery is the eighth most common plastic surgery procedure performed globally (Kraut et al. 2017). It’s a procedure that can offer a woman many psychological and physical benefits, but it can also impair breastfeeding if too much functional glandular tissue has been removed, or if the nipple is moved to a new position during surgery. With time, however, it is possible for some regrowth of the nerve supply, and the remaining glandular tissue can still develop during pregnancy (Australian Breastfeeding Association 2015).
Kraut et al. (2017) conducted research to evaluate how breast reduction surgery impacts breastfeeding success - in particular, whether different surgical techniques impact breastfeeding success in different ways. They found that techniques that preserve the column of subareolar parenchyma appear to have a greater likelihood of success, and they suggest that women should be counselled about the importance of preservation of the column of subareolar parenchyma prior to surgery (Kraut et al. 2017).
Davanzo (2018) also explored this topic and conducted a systematic review of 51 observational studies on the impact of breast reduction surgery on breastfeeding success. Results of this research also confirmed that preservation of the subareolar parenchyma, from the nipple-areola complex to the chest wall, was essential for successful breastfeeding. By contrast, when the subareolar parenchyma was not preserved, only 4% of women could be expected to breastfeed successfully. Preservation of the fourth intercostal nerve is also important as this plays a vital role in triggering the release of prolactin and oxytocin.
Additional factors that influence successful breastfeeding after breast reduction include:
Breastfeeding may also be possible for women who have had a full or partial mastectomy for breast cancer if they can breastfeed from the other breast, or if sufficient functional glandular tissue remains on the affected side (Australian Breastfeeding Association 2015).
It remains the case, however, that many women are not adequately advised that a lack of glandular tissue through breast reduction surgery, or the pressures placed on the milk-producing tissue through breast augmentation, can reduce their ability to breastfeed (BFAR 2016).
Despite these challenges, Davanzo (2018) suggests that the support and attitude of the maternity team can make a significant impact on a woman’s ability to breastfeed successfully. In particular, they suggest that failure to distinguish between a contraindication and an obstacle to feeding can be confusing to a new mother and that success, or failure, depends to a large extent on the support a mother receives in the early postnatal days.