Jan 9, 2016 - breast milk may also need protection. In the year 2001,. 206,354 women underwent breast augmentation in the. United States, a 533% ...
EDITORIAL Nommsen-Rivers
Guest Editorial
Guest Editorial Cosmetic Breast Surgery—Is Breastfeeding at Risk? Laurie Nommsen-Rivers, MS, RD, IBCLC 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 1992.1 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 1 was not related to postmastectomy reconstruction). Here in California, cosmetic breast surgery is especially common: 1 in 7 California women are estimated to have 2 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 3 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 1 ability to nurse.” Although the medical literature is sparse, studies conducted by lactation experts4-6 and 7,8 plastic surgeons show that previous breast surgery significantly increases the risk of inadequate milk supply. However, the conclusions drawn from these studies vary J Hum Lact 19(1), 2003 DOI: 10.1177/0890334402239729 Copyright 2003 International Lactation Consultant Association
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 9 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 10,11 Nancy Hurst, our guest lactation in the US media. 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 3 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 12 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 7
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Nommsen-Rivers
breasts. Lactation consultants should know where to refer large-breasted clients for supportive bras, be aware of what clothing styles work well for fuller figures, and have physical therapy resources available for those experiencing neck and shoulder pain from heavy breasts. Beyond these measures, I would like to go a step further and propose that cosmetic breast surgery be held to the same standards as other elective practices that threaten the reproductive cycle. No doubt, biases exist in the available literature regarding breast surgery. Certainly, many women with implants go on to fully lactate. The actual risk likely varies depending on the type of procedure and the individual woman. There are many unknowns regarding how best to preserve lactation capacity, and more research may shed some light on the matter. However, enough evidence exists to warrant informing consumers of the potential for harm. Just as cigarette advertisements in the United States must carry a warning of potential harm to the fetus, so should advertisements for breast augmentation carry warnings of potential harm to subsequent lactation. The content of informed-consent documents should be standardized and include evidence-based data regarding the risks to exclusive breastfeeding, benefits of breastfeeding, and its importance in current infant feeding recommendations. Let us all do our part to protect breastfeeding by emphasizing the wonderful diversity of “normal”
J Hum Lact 19(1), 2003
breasts and promoting informed choice regarding cosmetic breast surgery. References 1. Plastic Surgery Information Service. Available at: http://www.plasticsurgery. org. Accessed April 30, 2002. 2. Breast implant statistics and demographics. Available at: http://biomed .brown.edu/courses/bi108/bI108_2000_groups/breast_implants/pages/ stats.htm. Accessed June 24, 2002. 3. INAMED Aesthetics. Breast augmentation—US physician: Saline-filled implants—Risk information. Available at: http://www.inamed.com/ products/aug/us/physicians/saline/rish.html. Accessed July 13, 2002. 4. Hurst N. Lactation after augmentation mammoplasty. Obstet Gynecol. 1996;87:30-34. 5. Neifert M, DeMarzo S, Seacat J, Young D, Leff M, Orleans M. The influence of breast surgery, breast appearance, and pregnancy induced breast changes on lactation sufficiency as measured by infant weight gain. Birth. 1990;17:31-38. 6. Souto GC, Giugliani ERJ, Giugliani C, Schneider MA. The impact of breast reduction surgery on breastfeeding performance. J Hum Lact. 2003;19:43-49. 7. Brzozowski D, Niessen M, Evans B, Hurst L. Breast-feeding after inferior pedicle reduction mammoplasty. Plast Reconstr Surg. 2000; 105:530-534. 8. Marshall D, Calla P, Nicholson W. Breastfeeding after reduction mammoplasty. Br J Plast Surg. 1994;47:167-169. 9. World Health Organization. The optimal duration of exclusive breastfeeding. Note for the press No. 7. Available at: http://www.who.int/infpr-2001/en/note2001-07.html. 10. Morgan H. My body: fix my boobs—When DD is just too big. Seventeen. 2002:31-34, 122-124. 11. Minkin D. The surgery women love. Prevention. 1999:87. 12. US Food and Drug Administration. Breast implants—an information update—2000. Available at: http://www.fda.gov/cdrh/breastimplants. Accessed July 13, 2002.
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