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February 03, 2008

Breast Implants: "Should I Wait Until I've Completed All My Pregnancies?"

It's up to you.

Many young women are interested both in breast augmentation and in having children.  They frequently wonder...

  • Are breast implants dangerous for the baby?
  • Do breast implants create issues when breast feeding?
  • Will the implants still look good after pregnancies?

My short answers:

  • Among mothers with implants, breast feeding is safe for the babies.
  • On the other hand, breast implants may decrease the chance (by about 5-10%) that a mother can successfully breast feed.
  • Breast implants may improve chest appearance both before and after pregnancies and breast feeding.
  • Ultimately, a patient must decide for herself after she has had a chance to consider the facts....

Here are my long answers, with all the facts:

A woman who is interested in breast implants and in motherhood should weigh the plusses and minusses of both options.

One school of thought is to do the surgery when you want it.  If you want a breast augmentation now, then do it now!  You might not have your children for another 5-10 years.  Why should you go without the implants for that relatively long period of time?

Moreover, breast implants are safe for children.  They do not contaminate the breast milk.

And implants may actually improve breast appearance after pregnancies and lactation.  Often, women lose fullness in the upper halves of their breasts after children and breast feeding.  In recent mothers, I frequently place implants to increase upper pole volume, and sometimes I add breast lifts to position the nipple properly.  If a patient has already had a breast augmentation, then I usually need to perform the lifts (called mastopexies) only.

Implants are not, however, without some risks.  Large implants can stretch nerves, especially the nerves that provide sensation to the nipples and areolas.  If those nerves are excessively stretched, then the nipples and areolas can become numb.  If the nipples and areolas are numb, the breasts might not produce enough milk.  Nipple-areolar numbness is uncommon but not rare; about 5-10% of patients do notice some degree of numbness.

Another way that breast implants affect lactation is incision location.  One of my favorite incisions for breast augmentations is from 3 o'clock to 9 o'clock around the lower half of the areola.  However, I never use this incision if a woman intends to breast feed.  I want to avoid severing any milk ducts that might be important for lactation.  Instead, I recommend an inframammary incision (in the fold under the breast).

(By the way, I no longer do armpit or bellybutton incisions.  These were both novelty incisions, through which I have never seen perfect resultseither in my own patients or in anybody elses.  I am very fussy, and I am only satisfied when the breasts are perfect.  With armpit and bellybutton incisions, the results are just too unpredictable.)

So, the bottom line:  a patient must decide for herself....

    • If you'd feel better about your chest appearance with implants now, then let's proceed.
    • You shouldn't worry that you are putting your baby at risk.
    • I'd recommend an implant on the smaller side (that will be less likely to cause nipple numbness).
    • And we should agree that an incision in the fold underneath the breast will be safest.
    • However, if you really want to maximize the chance that you will be able to successfully breast feed, then I must admit that we should wait until after your pregnancies; you'll probably have a 5-10% greater chance of being able to breast feed your baby.

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