Pregnancy and Breast Implants
Pregnancy and Breast Implants
Breast augmentation is currently the most popular cosmetic surgical procedure in the United States. There are two primary groups of patients who request this surgery. There are women who have always had small breasts and wish to be made larger. And there are women who seek breast augmentation because pregnancy has caused their breasts to lose their fullness. Women in this latter category may also have some sag to their breasts. If the patient has also breast fed, her breasts may have more sag than patients who have bottle fed their babies. In fact, it is not unusual to find that women who have breast fed favoring one breast, end up with asymmetrical breasts and that the favored breast sags more. Readers should not interpret this to mean that they should not breast feed, but rather understand that these are typical situations that Dr. Moss deals with on a daily basis.
Breast feeding can cause sag to a woman’s breasts. However, in most cases breast feeding is considered a very viable option for today’s mother.
Young women who have never been pregnant and have small breasts, rarely have breast sag of any significance to their breasts. A woman who has experienced large weight gains and losses (50 pounds or more) may find she has breast sag even if she has never been pregnant. A woman who has both experienced pregnancy(s) and large weight gains and losses is very likely to have sag to her breasts. Breast augmentation does not lift breasts, however many patients with pre-existing breast sag find that after breast augmentation surgery, that they wish no further surgery to their breasts. If a patient feels that she does want her breasts lifted after breast augmentation surgery, Dr. Moss will discuss the available options concerning breast lift surgery, also referred to as mastopexy.
This patient is a young 24 year old woman who has never had any children. She has no breast sag. This patient had Moderate Profile 457 cc Natrelle® Silicone Gel Breast Implants. She has an excellent result that is typical of young women who have had no children.
Patients need to be aware that most mastopexy surgeries do produce significant scarring to the breasts as opposed to breast augmentation surgery, which usually results in much more limited and usually much less visible scarring. While scarring usually fades with time it does not disappear. Breast lift surgery will not produce a permanent result and patients should consider this in their decision to have mastopexy surgery. It is not uncommon for patients to have another breast lift later in life, if the sag returns. If a patient’s breasts have any significant level of sag (also referred to as ptosis), Dr. Moss will always discuss with a patient what her options are concerning breast augmentation and/or breast lift before undertaking any cosmetic breast procedure.
This woman is 30 years old and has had 3 pregnancies and childbirths. Her pre-operative pictures demonstrate some breast sag and asymmetry. She had breast augmentation surgery with 375 cc Natrelle® High Profile Silicone Gel Implants. While some asymmetry and breast sag remain after breast augmentation, her breasts now have a nice fullness to them. This patient could have a breast lift if she chose, however she would need to be accepting of scars. This patient has lovely cleavage and fullness to her breasts when she wears a bra.
Breast ptosis is a condition that describes the level of sag of the nipple in relationship to the inframmary crease (junction of the breast to chest wall, underneath the breast). There is also another term called pseudo ptosis which describes the amount of sag to the lower part of the breast structure, below the nipple. Having breast augmentation surgery does not prevent either type of sag from occurring later in life. Breast sag is one of those conditions that happens and can be related to pregnancies, breast feeding, weight gain and loss, aging, or simply one’s genetics.
When researching breast augmentation on the internet it is important to understand that what a patient’s breasts look like before surgery will affect the final result.
One of the most frequently asked questions concerning breast augmentation and pregnancy is “Can I have breast augmentation surgery if I still want to have children?” The answer is yes. If you become pregnant after having breast implant surgery, your breasts will grow and go through all of the normal changes associated with pregnancy.
These pictures show a 40 year old woman who had already had 2 pregnancies and childbirths before having breast augmentation. She chose 300 cc Natrelle® High Profile Breast Implants. She did have one more child after having her breast implant surgery. These pictures show her breasts before breast implant surgery, then at 7 months post operatively. At one year post operatively the patient was pregnant and these pictures demonstrate the normal breast enlargement that takes place with pregnancy. The last pictures demonstrate the patient at 2 years post operatively, and no longer pregnant.
However, it is important that a breast augmentation patient not get pregnant for 6 months following her breast augmentation surgery. The reason for this is that during breast augmentation surgery the milk ducts are transected. At six months post operatively these transected milk ducts should be sealed off. Milk production is one of the natural hormonal responses to pregnancy. Should these transected milk ducts not be given adequate time to seal off, milk could flow into the breast implant cavity and cause a problem called a “galactoma”. Because there are more milk ducts above the pectoralis major muscle than below the pectoralis major muscle, the problem of galactomas (in a situation of a pregnancy within six months of breast implant surgery) could be more of an issue with a breast implant that had been placed above the muscle than below the muscle. Galactomas are not usually a problem with either placement of breast implants, if pregnancy has not happened within six months of breast augmentation surgery.
The next question that is frequently asked is “Can I breast feed any children I might have in the future, if I have breast implants?” Dr. Moss’ first response to this question is “Many women, who have never had any breast surgery whatsoever, are unable to breast feed when they attempt to, after childbirth.” However, once the patient is informed of this fact Dr. Moss then elaborates that “Many women with breast implants are able to successfully breast feed.” In fact Dr. Moss has many women on whom he has performed breast reduction surgery, who have been able to breast feed later on. Breast reduction surgery is a much more extensive surgery to the breasts and is known to carry a much higher incidence of disruption of the milk ducts, than breast augmentation.
Some surgeons feel that if a woman finds breast feeding in the future important to her, that she consider the inframmary approach (incision at the inframmary crease, under the breast), as opposed to the peri-areola approach, (incision around the areaola and nipple complex). This is because there have been some breastfeeding difficulties reported, following breast surgery, particularly when the surgeon uses the peri-areolar incision. Patients should always voice any post breast augmentation surgery concerns and goals, when discussing this surgery with Dr. Moss or any other plastic surgeon.
Another question less frequently asked, but just as important is “How long do I have to wait to have breast enlargement surgery, after childbirth?” A woman needs to wait six months after childbirth and six months after cessation of breast feeding (whatever comes last) in order to have breast augmentation surgery. This is to prevent a galactoma which was discussed above. Therefore, any woman who is breastfeeding and considering breast augmentation surgery should keep accurate records on her last breast feeding event. It should be noted that any pumping of the breasts also counts as a breast feeding event. In addition, it does not matter if the breast feeding frequency was less near the end; it is simply the last time a woman breast fed her child that is the beginning of the six month waiting period.
If a woman is eager to have breast augmentation as soon as possible after childbirth and breast feeding, she should carefully record the last time she breast fed her baby.
It is not unusual for Dr. Moss’ staff to receive a phone call from a distressed mom (with baby crying in the background). These women can exhibit signs of sadness and distress over what they perceive as a total destruction of their body. And they want an immediate overhaul. If they have stopped breast feeding (or never started) they find themselves with deflated breasts after enjoying months of full breasts, often for the first time in their lives. Add newly acquired breast sag, a still bulging and wrinkled abdomen, not to mention the un-lost pregnancy weight, and we have a very unhappy woman. Then add lack of sleep to the equation, possibly post partum depression, and it’s easy to understand why Dr. Moss’ staff might suggest taking a slower approach to a cosmetic “mommy makeovers”.
As much as Dr. Moss and his staff want to help all prospective patients achieve their goal of a more beautiful body, patient safety and well being are always a first priority. Any patient considering cosmetic surgery needs to be able to handle the increased stress and discomfort of surgery. And with a new baby, there also needs to be appropriate child care, in place for at least one to two weeks after surgery. Dr. Moss’ staff will always explore the resources a prospective patient has for post operative care and childcare with any new mom, before scheduling a consultation for any cosmetic procedure.
Dr. Moss finds that many women come in for breast augmentation surgery when their youngest child is around five years old. At this time they find that some of the child care demands are not quite as burdensome as when they are caring for an infant.
For moms who are considering breast augmentation surgery after childbirth and are “doing well,” Dr. Moss will consider breast augmentation surgery at the six month, post delivery date or six month, post breast feeding, cessation date, whichever comes last. It is best to schedule the consultation at least three months out from childbirth and/or cessation of breast feeding so that the breasts will more likely resemble their size and shape at surgery. A final sizing and review of the goals of surgery will take place approximately two weeks before surgery, to ensure accurate implant size, and an understanding between patient and Dr. Moss of realistic goals of the surgery.
While it may seem obvious, Dr. Moss would like to point out that breast augmentation surgery, like any other cosmetic surgery procedure, should not be performed while a patient is pregnant. Besides the above mentioned problems of galactomas, there is always the safety of the fetus to consider. Anesthesiologists will usually not consider anesthesia for surgery on a pregnant woman unless it is necessary for the safety of either the mother or fetus. Any woman considering cosmetic surgery of any type should be confident that she is not pregnant, and should either use birth control if sexually active, or refrain from sexual intercourse, until safe to do so. Dr. Moss encourages patients to bring up any questions they might have in this area.
