Can you breastfeed after breast surgery?

Why is breastfeeding a concern with breast surgery?

Many women considering breast surgery are planning on pregnancy and childbirth in the future. A 2018 meta-analysis also explained that many women have implant surgery during their childbearing years, but that the long-term effects are still debated ^[1].

Breastfeeding is regarded as the standard for infant nutrition, and current guidelines recommend exclusive breastfeeding for 6 months and continued breastfeeding until 24 months or beyond ^[2]. That is why how breast surgery affects breastfeeding is a question worth understanding before surgery.

The research summaries reviewed here mainly addressed breast augmentation with implants for cosmetic purposes. They did not include data on breastfeeding after surgery that removes or moves breast tissue, such as breast reduction or a breast lift, so if you have had or are planning such surgery, it is a good idea to get a separate consultation.

How implants affect breastfeeding

The 2018 meta-analysis analyzed 4 cohort studies and 1 cross-sectional study ^[1]. Women with implants had a significantly lower rate of exclusive breastfeeding (feeding the baby only breast milk) than women without implants, with a pooled relative risk of 0.63 (95% confidence interval 0.46 to 0.86) ^[1]. The rate of breastfeeding was also lower, with a pooled relative risk of 0.88 (95% confidence interval 0.81 to 0.95) ^[1].

The authors concluded that women with implants are less likely to start breastfeeding, especially exclusive breastfeeding ^[1]. This means that the likelihood is lower, not that breastfeeding is impossible. In addition, because these results combine observational studies, it is difficult to tell from this analysis alone whether the implants themselves are the cause or whether other factors also played a part.

Does it depend on the incision site?

A common worry is that an incision around the areola might make breastfeeding harder. In the same meta-analysis, the pooled relative risk comparing the areola incision with the breast fold incision was 0.84 (95% confidence interval 0.45 to 1.58), and there was no evidence that the areola incision lowers the rate of exclusive breastfeeding ^[1].

However, it should also be noted that little data were available for this comparison, so the confidence interval is wide. If you plan to breastfeed, it is a good idea to say so in advance when the incision site and implant position are being decided.

Rare complications: milk discharge and milk cysts

Rarely, after breast augmentation, milk may come out of the breast (galactorrhea) or collect in a pocket (galactocele). A 2021 systematic review gathered 38 cases from 19 publications. The average age was 28, and 21 patients had milk discharge, 7 had milk cysts, and 10 had both ^[3].

Symptoms began an average of 61 days after surgery, 72% had symptoms in both breasts, and 62% had high levels of prolactin, the hormone that stimulates milk production ^[3]. The cases were managed in various ways, including observation, medication, surgical washout, and implant removal, and it took an average of 22.6 days for symptoms to resolve ^[3].

The authors stated that there were too few cases to be certain, but weakly suggested that an incision around the areola, implants under the breast gland, a history of taking hormonal birth control pills, a history of pregnancy, and recent breastfeeding within the past year may be risk factors ^[3]. If you have recently given birth or finished breastfeeding, it is a good idea to discuss the timing of surgery during your consultation.

Preparing before childbirth and getting support

A 2023 review explained that obstetric care providers should begin breastfeeding education during pregnancy and continue support after birth, and that people who are worried because they have had breast augmentation should also be included ^[2]. If you have had breast surgery, it helps to mention it at your prenatal visits and to get breastfeeding counseling.

Some research has found that breast milk and breast tissue have their own communities of microorganisms. A 2020 review considered that microorganisms may be present in breast tissue whether or not a person has breastfed, and that they may possibly be linked to some adverse reactions related to implants, but it summarized that many questions remain unanswered ^[4].

What to check during your consultation

The effect on breastfeeding can vary depending on the surgical method and the condition of your breast tissue. It is a good idea to check the following during your examination before surgery.

• Your plans for future pregnancy and breastfeeding
• How the incision site and implant position may affect breastfeeding
• If you have recently given birth or breastfed, the appropriate timing for surgery
• What to do if milk discharge or swelling appears after surgery
• For a breast reduction or breast lift, how much of the breast tissue will be involved