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I am often asked by patients and by women who are considering breast implantation surgery whether their decision to have surgery could affect pregnancy or their ability to breastfeed. Because I am board-certified in both Pediatrics and Plastic Surgery, I am particularly interested in these areas of research. There are a number of studies and reports that explore the topic of breast implants and pregnancy, child health and breastfeeding, as well as the quality of the breast milk produced by women with breast implants. The results of these studies and reports can help women interested in breast implantation surgery — and those who already have breast implants – make informed decisions for themselves and their children.

Read studies and reports on breastfeeding

Breast Implants and Pregnancy

Although the topic rarely comes up among my patients, it is important to note that there is no evidence or studies that show breast implants affect a woman's ability to become pregnant or deliver a baby. In general, a woman's breasts do increase in size during pregnancy, and occasionally, women with breast implants experience breast discomfort during pregnancy because of the additional weight they carry in their chest area.

A common question my patients ask is whether breast augmentation should be delayed until after pregnancy. When I consult with a patient, I tell her that often the breasts do not return to their earlier size and shape after pregnancy (this occurs whether or not the breasts have been augmented), and let them choose whether or not to proceed with surgery. I generally recommend that breast augmentation be delayed if pregnancy is planned within the next six months, mainly because the change in breast size and shape during pregnancy may interfere with the normal healing process after surgery.

Breast Implants and Child Health

During the early 1990's, a few small case reports raised concern that infants and children born to women with silicone gel-filled breast implants may experience health issues as a result of being exposed to silicone during pregnancy or breastfeeding. 1,2,3 The health concerns expressed in these isolated cases included problems with the esophagus, such as difficulty swallowing, and a set of disorders that affect the immune system (referred to as autoimmune diseases or connective tissue diseases).

When I consult with women who are considering silicone gel-filled breast implants, I review this information and also stress that these reports were based on very few medical cases, and that numerous analyses and studies have since concluded that the case findings are not valid.4

I also discuss a number of well-recognized studies that have explored this topic in depth, to provide my patients with a better understanding of the relationship between silicone gel-filled breast implants and children's health. One of these was a Danish study involving more than 1,000 patients that looked at the risk of esophageal disorders, connective tissue disease, other rheumatic conditions, and birth defects (often referred to as "congenital malformations") among the children born to women with and without breast implants. The conclusion from this study was that the children born after their mother's breast augmentation surgery did not have a higher incidence of esophageal disorders or any congenital malformations. The study also found no significant increase in connective tissue diseases or congenital malformations among women who had breast implants or breast reduction. Furthermore, none of the children in the study were diagnosed with any type of rheumatic condition.5

In the late 1990's, the Institute of Medicine (IOM) asked a group of experts to evaluate the impact of breast implants on women's health, including the potential of any health effects on infants born to women with breast implants. In 1999, this expert panel wrote and published a report that summarized the conclusions of a number of studies related to this topic. The IOM panel concluded, "Evidence for an association of maternal silicone gel-filled breast implants and children's health effects is insufficient or flawed." The committee could not find a biological reason for any health effects to occur among the children of women with silicone gel-filled breast implants.6

Read the IOM's report

Breast Implants and Breastfeeding

Most women who plan to breastfeed their children – whether they have breast implants already, or are considering surgery in the future – have important questions about how breastfeeding will work for them. The most important piece of advice that I give to my patients on this topic is that regardless of whether or not you have had breast implantation surgery, there is nothing that should stop you from attempting to breastfeed your baby. This advice is based on more than 15 years of personal experience as a physician, conclusions from several well-recognized studies, and a report from the American Academy of Pediatrics (AAP), which in 2001 concluded there is no reason why babies of women with silicone gel-filled breast implants should not be breastfed.

I also make sure my patients are aware that some women will naturally experience problems with breastfeeding, whether they have breast implants or not. In their 1999 report, the IOM noted that about one out of every four women (with or without implants) has trouble breastfeeding.6 The more information, resources and support women can gather prior to having a baby, the better equipped they will be to address any challenges and meet their breastfeeding goals.

Women who are considering breast implants and plan to breastfeed should talk with their surgeon about the surgical technique he or she plans to use and how that could potentially impact breastfeeding. There are several viewpoints among surgeons on this topic. It is generally agreed that any surgery on the breast, for whatever reason (for example, breast reduction, biopsy, breast lift, breast augmentation), could impact a woman's ability to breastfeed. There is always a possibility that the nerves and/or milk ducts involved in lactation may be impacted during surgery. According to the 1999 IOM report, the risk of reduced milk production (also known as "lactation insufficiency") is at least three times greater in women with a history of any type of breast surgery.

I also believe it is important to discuss with my patients who are considering breast implants the location of the incision I will make during surgery. There are two often-quoted studies that associate what is known as the "periareolar" breast augmentation technique with an increased risk of lactation insufficiency. Periareolar refers to a surgical approach that requires an incision around the areola of the breast through which the breast implant is placed, and some researchers have suggested that this method of breast implantation surgery could damage more milk ducts than other breast augmentation techniques. The first study on this subject interviewed just 42 women who had undergone breast augmentation at some time in the past.7 The second study examined 319 women, only one of whom had a periareolar incision from breast augmentation.8 Although I would not advise patients to make any medical decisions based on these "after the fact" studies that involved a relatively small number of patients, I usually consider another approach for my patients who want to breastfeed after breast implantation surgery. Overall though, the single most important factor in preserving the health and functioning of the breast after breast implantation surgery is finding a specialized surgeon who fully understands the anatomy and physiology of the breast, as well as how the breast responds to surgery.

In summary, the factors that impact the ability to breastfeed are different and unique for every mother and baby. I encourage all women, whether or not they have breast implants, to talk to their personal physicians and their child's pediatrician about their breastfeeding goals and any potential obstacles to these goals, so that they can develop solutions that are most appropriate for their individual needs.

Quality of Breast Milk Produced by Women with Breast Implants

In addition to questions about the ability to breastfeed, some patients have asked me whether breast implants can affect the quality of their breast milk. A significant amount of research has been conducted on this important question, particularly looking at whether silicone from silicone gel-filled breast implants could be found in the breast milk of a woman with breast implants.

There are two factors to consider when exploring the impact of silicone gel-filled breast implants on breast milk. First, does silicone actually escape or "leak" from a breast implant? The silicone gel-filled breast implants manufactured and sold around the world today have thicker shells and a more cohesive gel, and were designed this way to greatly reduce the potential that implants will rupture, and to reduce the likelihood that gel will migrate into the body. Recent, well-controlled studies evaluating the rupture rate of today's silicone gel-filled breast implants suggest that between 0.3 and 17 percent of them will rupture within 10 to 15 years.9,10,11 Other recent studies conducted by Allergan, Inc. as part of the U.S. Food and Drug Administration (FDA) approval process, show an overall rupture rate of 1.3 percent at four years.12 Specifically, Allergan's data looking at rupture rate by implant showed that nearly 99 percent of implants are intact at four years. (Note that, similar to other medical devices, silicone gel-filled breast implants are not lifetime devices. It is possible that at some point in a patient's lifetime, the implant(s) would need to be removed or replaced. Therefore, it is critically important to maintain regular communication with your physician if you have breast implants.)

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The next question I sometimes hear from my patients is whether silicone from a silicone gel-filled breast implant would ever enter the breast milk. My response is that there are currently no methods to accurately detect pure silicone levels in breast milk. Testing has instead been performed on silicon, a component of the pure silicone molecule that can be detected. The conclusions of these tests did not identify higher levels of silicon in breast milk from women who had silicone gel-filled breast implants, as compared to women without implants.13 Another study compared the levels of silicon in the breast milk of women with and without silicone gel-filled breast implants, as well as store-bought cow's milk and commercial baby formula. Silicon levels were similar in the breast milk of women with and without silicone gel-filled breast implants, and were actually much lower in both breast milk samples than in cows' milk or commercial baby formula.14 The silicon found in the store-bought products likely came from the containers in which the formula and cow's milk are sold. A silicone molecule itself is quite large, and would likely be blocked from entering the breast milk by the body's own biological membranes within a woman's breast.

In preparing their 1999 report, the IOM looked extensively at this question and stated, "Convincing evidence is available that silicone concentrations in breast milk are the same in mothers with and without breast implants, and thus there are no data to support transmission of silicone to infants in breast milk of mothers with implants." The IOM also concluded that there is "...no evidence of elevated silicone in breast milk or any substance found in women with silicone gel-filled breast implants that would be harmful to infants."6 I also tell my patients something that is not commonly known: silicone is almost everywhere in our environment, and children have come into contact with the substance for decades through pacifiers, baby bottle nipples, simethicone (Mylicon®) drops for gassiness, antacids, and the coatings of fruits and vegetables found in many grocery stores.

One Last Point: Mammograms

I tell all of my patients – including those considering breast augmentation and those who already have breast implants – that they must get mammograms as recommended. This is a critical part of protecting their health and the well-being of their families. Many women who have breast implants worry that the mammogram procedure will damage their implants, so they delay their mammograms, or neglect them altogether. While it is true that breast implants can make routine screening mammography slightly more involved for the radiologist, it does not mean the breast implants will be affected or damaged and that women should avoid screenings. Today's implants are designed to withstand 25 times the pressure of a mammogram (and much more!). Ask your physician to direct you to a screening facility that practices implant displacement technique, which has been shown to improve the accuracy of mammograms in women with breast implants. Simply tell the radiological technician conducting your screening that you have breast implants – they will modify the procedure to ensure you get the best exam possible.

Q.

Will breast augmentation affect my ability to breastfeed?

A.

The majority of women who want to breastfeed their baby after having breast implantation surgery are able to without any problems. However, your likelihood of experiencing insufficient milk production is greater if you have had any type of breast surgery. Regardless of whether a woman has had breast surgery or not, she may experience difficulty generating enough milk to feed her baby solely with breast milk, and will need to supplement with formula.

I cannot stress enough how important it is to share your future plans, as well as any concerns you may have about breast implantation surgery, with your personal physician and/or your surgeon. Discuss the type of surgery he or she will perform and the potential impact on your ability to breastfeed. The single most important factor in preserving the health and functioning of your breasts is to ensure that any breast surgery you have is performed by a specialized surgeon who fully understands the anatomy and physiology of the breast, as well as how breasts respond to surgery.

Q.

Will pregnancy, childbirth or breastfeeding have an impact on how the breast implants will look?

A.

Breast size and shape change during pregnancy, whether or not the breasts have been augmented. I am not aware of any studies that investigated whether augmentation makes these changes more or less apparent, or whether women with breast implants experience more discomfort from the increase in breast weight and size than women without implants. I have not read about, or seen among my patients, any impact to breast implants from pregnancy, childbirth or breastfeeding beyond the normal pregnancy-related changes to the breast.

Q.

If my silicone gel-filled implant ruptures while I'm pregnant, can it harm my baby?

A.

There is no scientific evidence demonstrating that silicone released into the body from a breast implant can harm, or even reach, a fetus. Furthermore, the silicone gel-filled breast implants used today have been designed for long-term durability. These implants have thick outer shells reinforced by a silicone patch and a barrier layer and are filled with a cohesive internal gel. In most cases, if the outer shell of a silicone gel-filled breast implant were pierced or cut, the silicone gel filler would remain intact.

Read about the strength and durability of today's silicone gel-filled breast implants

Q.

Since my breasts will get bigger during pregnancy, will I be able to tell if an implant has ruptured?

A.

There is no correlation between breast size and the ability to tell whether an implant has ruptured. If you suspect your implant has ruptured – for any reason – you should alert your personal physician or surgeon as soon as possible. The best way to determine rupture of a silicone gel-filled breast implant is through magnetic resonance imaging (MRI). Similar to other medical devices, silicone gel-filled breast implants are not lifetime devices. It is possible that at some point in a patient's lifetime, the implant(s) would need to be removed or replaced. Therefore, it is critically important to maintain regular communication with your physician regarding the status of your breast implants. The United States Food and Drug Administration (FDA) recommends that women with silicone gel-filled breast implants have an MRI three years following implantation and every two years thereafter.

Q.

Where can I find breastfeeding resources and support?

A.

For more information about these topics, I direct my patients to these two resources:

• National Institutes of Health Visit the NIH web site
• American Academy of Pediatrics Visit the AAP web site

Click here for a list of studies that have explored breast implants, pregnancy, breastfeeding and children's health

1 Gedalia, A, Cuellar, ML, and Espinoza, LR. "Skin rash and anti-Ro/SS-A antibodies in an infant from a mother with silicone breast implants". Clin Exp Rheumatol 1995;13(4):521-523
2 Levine, JJ and Ilowite, NT. "Sclerodermalike esophageal disease in children breast-fed by mothers with silicone breast implants". JAMA 1994;271(3):213-216
3 Teuber, SS and Gershwin, ME. "Autoantibodies and clinical rheumatic complaints in two children of women with silicone breast implants". Int Arch Allergy Immunol 1994;103(1):105-108
4 Lipworth, L, Nyren, O, Ye, W, Fryzek, JP, Tarone, RE, McLaughlin, JK. "Excess Mortality from Suicide and Other External Causes of Death Among Women with Cosmetic Breast Implants". Annals of Plastic Surgery 2007; 59(2):119-123.
5 Kjoller, K, McLaughlin, JK, Friis, S, et al. "Health outcomes in offspring of mothers with breast implants". Pediatrics 1998;102(5):1112-1115
6 Bondurant S, Ernster V, Herdman R. "Safety of Silicone Breast Implants, Report of the Committee on the Safety of Silicone Breast Implants (Institute of Medicine)". Washington, D.C.: National Academy Press, 1999
7 Hurst, N.M., "Lactation After Augmentation Mammoplasty", Obstetrics & Gynecology, 1996; 87: 30-34.
8 Niefert 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, Mar;17:31-38.
9 Hedén P, et. al. "Style 410 cohesive silicone breast implants: safety and effectiveness at 5 to 9 years after implantation". Plast Reconstr Surg 2006;118(6):1281-1287
10 Hedén P, et. al. "Prevalence of rupture in Inamed silicone breast implants". Plast Reconstr Surg 2006;118(2):303-308
11 Holmich, LR, et al. "Incidence of silicone breast implant rupture". Arch Surg 2003;138(7):801-806
12 Allergan Core Studies
13 Lugowski, SJ, et. al., "Analysis of silicon in human tissues with special reference to silicone breast implants". J. Trace Elem. Med. Biol. 2000;14(1):31-42.
14 Semple JL, Lugowski SJ, Baines CJ, et al. "Breast milk contamination and silicone implants: preliminary results using silicon as a proxy measurement for silicone". Plast Reconstr Surg.1998; 102 :528 -533
15 Strom, S.S., Baldwin, B.J., Sigurdson, A.J., Schusterman, M.A., "Cosmetic Saline Breast Implants: A Survey of Satisfaction, Breast-Feeding Experience, Cancer Screening, and Health", Plastic and Reconstructive Surgery, 1997; 100: 1553-1557.