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Cosmetic Breast Surgery—Is Breastfeeding at Risk?

As lactation consultants, we work to promote, protect, and support breastfeeding. When I think of protecting breastfeeding, what usually comes to mind is guarding against unethical marketing of breast milk substitutes. However, as cosmetic breast surgery becomes increasingly popular, the very “machinery” that produces breast milk may also need protection. In the year 2001, 206,354 women underwent breast augmentation in the United States, a 533% increase since 1992. Fifty-six percent of augmentation clients were younger than 35 years of age, the vast majority of whom chose augmentation to enhance their breast size (ie, the augmentation was not related to postmastectomy reconstruction). Here in California, cosmetic breast surgery is especially common: 1 in 7 California women are estimated to have breast implants. These figures do not include other types of cosmetic breast surgery, also increasing in incidence, such as implant removal, breast-lift surgery, or breast reduction. The plastic-surgery literature emphasizes that any cosmetic breast surgery should be considered a maintenance procedure. Clients should expect to undergo additional surgery to maintain or improve the result. A recent clinical study conducted by McGhan Medical, a leading manufacturer of saline breast implants, reports a 3-year reoperation rate of 20%. As to whether cosmetic mammoplasty affects lactation, the opinions of plastic surgeons and lactation experts tend to differ. For example, information provided on a website sponsored by the American Society of Plastic Surgeons states, “There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse.” Although the medical literature is sparse, studies conducted by lactation experts and plastic surgeons show that previous breast surgery significantly increases the risk of inadequate milk supply. However, the conclusions drawn from these studies vary by discipline. From the perspective of many plastic surgeons, “being able to breastfeed” is interpreted as producing some milk, irrespective of whether supplementation is needed. From the pediatric or lactation consultant perspective, the goal is exclusive breastfeeding: the ability to produce an adequate volume of milk to solely nourish a young infant. Lactation consultants are keenly aware of this distinction. When milk supply is insufficient, the infant is denied the numerous advantages of exclusive breastfeeding, and the breastfeeding mother must engage in a complicated balancing act between maintaining (or boosting) the existing supply while ensuring the infant receives adequate nourishment. In this issue of JHL, special attention is focused on the effect of breast surgery on lactation. Souto and coauthors present data regarding the risk of lactation insufficiency following reduction mammoplasty, a relatively common surgery in Brazil and increasingly popularized in the US media. Nancy Hurst, our guest lactation consultant for this issue’s Consultants’ Corner column, provides further insight into lactation management following cosmetic breast surgery. We are pleased to share their insights with our readers, and we encourage your reflections and feedback. Perhaps lactation consultants observe more breasts than any other health care professionals. Our view of the normal breast spans a wide range. Sadly, the window of “normal” promoted by Western culture and media is narrowing, creating a society where performing surgery to the breast, despite a fairly high rate of complications, is becoming more “normal” than having an A or DD cup size. The US Food and Drug Administration produces a consumer handbook, available online, that provides information on breast augmentation—including risks to breastfeeding—to help consumers make an informed decision. As protectors of breastfeeding, it is important for lactation consultants to be familiar with cosmetic breast surgery procedures and risks. Of equal importance is that we educate ourselves regarding alternatives to surgery for those who are having difficulty with large