Breast Augmentation and Pregnancy
Dr. Cook addresses important issues and questions women have regarding breast augmentation and pregnancy.
Women considering breast augmentation who are of childbearing age should address two important issues.
The first issue is whether an augmented breast behaves any differently during pregnancy and breastfeeding than a breast that has not been augmented. The second issue is whether pregnancy and breastfeeding will have a negative impact on an augmented breast.
Here are some of the questions that my patients have asked me about breast augmentation and pregnancy:
Do breast implants affect the ability of a woman to be able to breast feed?
There have been several studies done in order to try to answer this important question. Although the studies are far from perfectly designed they do suggest some general observations.
In general women who have breast implants do not seem to be more likely to have problems with breastfeeding than women without breast implants.
Some studies suggest there may be a little more difficulty with breastfeeding in women who undergo breast augmentation via periareolar incisions when compared to women with incisions in the fold under the breast.
One important technical issue in terms of preserving nipple sensation and the ability to lactate is protection of the nerves that supply the nipple. The main nerves enter the under surface of the breast at its inner and outer borders. In order to protect these nerves the surgeon should avoid oversized implants that have a wider base than the natural base of the breast.
Do breast implants change the way breasts grow during pregnancy?
I have not seen any difference in the way breasts grow during pregnancy in my patients who have undergone breast augmentation when compared to the typical changes that occur with pregnancy. I have asked several of my ob-gyn colleagues whether they have seen a difference and they have replied that they have not. No one to my knowledge has studied this in a scientific way and it would be very difficult to do so.
I consider it very important to carry out breast augmentation in a way that respects the natural structure of the breast. Perhaps this is why my patients do not seem to have any problems with their augmented breasts when they become pregnant. I can imagine a different scenario when a patient goes to a surgeon who places a very large implant immediately beneath a breast with very small natural dimensions. I can picture two possibilities: either the implant could exert so much pressure on the natural breast structure that there would be inadequate breast structure to lactate, or if the natural breast were to grow during pregnancy with a very large implant beneath it, there might be a strange double contour.
Is it dangerous for a baby to breast feed from a mother who has breast implants?
All silicone gel implants currently available in the United States are filled with a cohesive form of the silicone polymer. This means that the filling sticks to itself and does not tend to spread if an implant shell is broken.
A baby is much more likely to ingest silicone as a result of its presence in skin lotions and over the counter medications. For example “simethicone,” an ingredient in many medications that combat indigestion, is simply another word for silicone.
One of the reason that silicone is present in so many of the medications that we take and lotions that we put on our bodies is that it is very non-reactive and has a long history of safe use in humans.
Will pregnancy damage the result of my breast augmentation?
The effect of pregnancy on an individual woman’s breasts is unpredictable. Some women can carry several pregnancies and breastfeed for many months yet have their breasts return to their original shape and volume. Other women may experience major changes in breast tone, volume, and position with a single pregnancy.
Once a woman has completed her pregnancies and breastfeeding she may choose to undergo a breast lift if the overall breast structure has lost tone. This is true whether her breasts were augmented or not.
Sometimes women who have undergone breast augmentation and subsequently become pregnant will experience a situation where the implant stays in its original position, but the natural breast structure settles to a lower position. One could argue that under these circumstances, an augmented breast with settled breast structure has a less natural appearance than someone without implants whose breasts have lost a similar volume after pregnancy. For the patient with implants under these circumstances a breast lift will restore visual harmony. For the patient without implants an augmentation with a breast lift will usually achieve the same result.
It has been my observation that as long as the implants are not very large an augmented breast tends to keep a balanced shape after pregnancy somewhat better than a breast that has not been augmented.
It is my opinion that the surgeon’s approach to the lower attachments of the pec muscle has an important influence on how the breast will respond to pregnancy. Proper release and, if appropriate, repositioning of the lower edge of the pec muscle helps the implant to stay in proper relation to the breast during and after pregnancy.
Does pregnancy increase the risk of my implants hardening due to capsular contracture?
Some patients who undergo breast augmentation surgery will develop a tightening of scar tissue around their implants known as capsular contracture. The likelihood of this occurring is relatively low. Most patients who develop capsular contracture reveal a tendency to do so in the first six months after surgery.
Sometimes patients develop a contracture years after their surgery. Most of the time this does not have any relationship to pregnancy.
I am aware of a few of my patients who have developed contractures during pregnancy. Given that I have performed a very large number of breast augmentations it does not seem to me that this represents a significant percentage of my patients.
In my patients at least there does not seem to be a significant association between pregnancy and the development of capsular contracture. Please keep in mind the vast majority of the breast augmentations that I perform are under the pec muscle, and this may have a positive influence on my patient statistics for contracture.