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Breastfeeding with cut ducts after mammoplasty. Breast reconstruction after childbirth: an integrated approach

During pregnancy, many women who have undergone breast surgery (breast surgery, breast reduction or enlargement, implantation, lift) worry about how it may affect breastfeeding.

Can a woman breastfeed after surgery?

Often, women who are about to undergo breast surgery are told that either there will be no problems with breastfeeding their future children, or that this is impossible in principle. Such extremes significantly affect future breastfeeding.

Most mothers who have previously had some kind of breast surgery can breastfeed their children, providing the full nutritional needs of the children. Some women need special measures to stimulate lactation. In some cases there is a need if others are excluded. It is impossible to determine in advance which of these groups a particular woman will fall into.

Before any breast surgery, it is important to discuss the prospect of breastfeeding with the surgeon, and the specialist will select the appropriate technique and manipulations to be performed during the operation to preserve the possibility of breastfeeding.

It matters how the tissue is affected during surgery.

Surgeons often perform a section along the edge of the areola - the so-called periareolar section. Such an incision in many cases causes insufficient milk production in lactating women.

This is due to the fact that such a section may damage the nerve fibers involved in the reflex arc that ensures the processes of milk production and separation. The degree of damage to nerve fibers during a periareolar section depends on whether it was carried out along the entire edge of the areola or only part of it. And also whether the nipple and areola were moved during the operation. Usually a section in this part of the chest is done because the scar from the operation “looks more beautiful” here. But such an incision has more postoperative consequences, in particular, the pain from such an incision is usually described as more severe.

Usually breast enlargement does not have a negative impact on further feeding, because In modern operations, the placement of implants does not affect the gland tissue itself. They are located directly behind the gland on the pectoralis major muscle or under the pectoralis major muscle.

If a woman has undergone breast augmentation surgery, the extent to which the nerves and ducts were excised also matters. If they were slightly affected, then there should be no problems with the amount of milk. It is important to consider that if mammoplasty was performed due to insufficiency of glandular tissue (breast hypoplasia), then the problem of lack of milk is associated with it rather than with the operation.

Reduction operation breast cancer can cause problems with milk supply. This is especially likely if the nipple was moved to a new location during mammoplasty, as this leads to disruption of the innervation of the nipple and areola. It also affects how much the mammary gland and milk ducts were affected during the operation. However, nerves can grow back and re-establish nerve connections, albeit slowly, and glandular tissue may develop slightly during pregnancy.

In case mastectomy(amputation of one of the mammary glands), even due to a history of cancer, a woman has the opportunity to feed her child with the second breast. With a double mastectomy, breastfeeding is unfortunately not possible.

Non-surgical methods: breast lift with threads (ligature plasty), mesotherapy, myostimulation, provided the procedures are successful, do not affect the glandular tissue and areola, so breastfeeding after these procedures is possible in full.

Often, women after breast surgery worry about various types of milk stagnation(lactostasis, mastitis). In most cases, operations have no effect on the development of congestion. If during the operation there was damage to the ducts or scarring after the operation, then the woman needs to pay special attention to the organization of breastfeeding and breastfeeding, since in these cases there may indeed be problems with the outflow of milk. in a woman with an operated breast, it is exactly the same as in all other cases (unless there are specific recommendations from the surgeon).

For a woman who has undergone breast surgery and is preparing to become a mother, the best option is to find in advance in your city, who will help prepare for the upcoming feeding and provide the necessary support after childbirth. We will be happy to help you make breastfeeding a pleasure.

Evgenia Simak, Alena Lukyanchuk, lactation consultants

Surgical procedures for breast augmentation with implants are becoming increasingly common. Women of childbearing age resort to this method of improving their appearance, and some even plan to become pregnant later. Breast augmentation usually uses silicone implants, which are placed below or above the pectoral muscle.

Pregnancy is the most important stage in the life of many women. Women who have breast implants are typically concerned about how it will affect their pregnancy and ability to breastfeed.

On the other hand, if a patient wants breast enlargement after childbirth, it is better to wait three months after breastfeeding ends. It is not possible to have breast enlargement during pregnancy because the breasts will constantly change throughout the pregnancy.

If patients become pregnant soon after surgery, before the breasts are completely healed, this is not a problem. During pregnancy, it is necessary to wear a supportive bra. By the time of delivery, the breast is usually completely healed, except for small scars at the incision sites.

Breastfeeding after reduction mammoplasty

The possibility of lactation after reduction mammoplasty ranges from full lactation to complete absence of milk. The method by which a mother chooses to feed her baby will depend on her baby's milk supply, comfort, and preferences. When consulting with a plastic surgeon prior to breast reduction surgery, women are typically advised that the procedure will affect their ability to lactate to some extent.

The mammary gland consists of many ducts. It is possible that some of the original number of ducts will remain unchanged after surgery. It is even possible that some of the ducts damaged by the operation may recover (a phenomenon known as "recanalization").

Practice shows that almost all women after reduction mammoplasty can produce breast milk.

But if a significant part of the lactation system has been disrupted during surgery, then the amount of milk will not be enough to fully satisfy the baby's nutritional requirements. After the operation, the following behavior patterns of patients were noted:

breastfeeding;
breastfeeding in combination with supplements;
unsuccessful attempts at breastfeeding;
no attempts to breastfeed.

Studies have shown that after breast reduction it is possible to restore some sensitivity to the nipple and areola. This will have a major impact on lactation since milk production depends largely on the response to nerve stimulation during breastfeeding.

Possibility of lactation after reduction mammoplasty

Research has shown that the question is not whether a woman will have milk. The real question is how much milk she will have. Indicators of the mother's basic lactation potential will be several important factors that determine the condition of the mammary gland.

Operation type

The starting point for determining baseline lactation capacity is the type of breast reduction surgery. This information is important because some mammoplasty techniques preserve more breast tissue than others.

The greatest capacity for lactation is preserved by operations during which the areolas and nipples are not completely damaged, although they can be moved. Surgical methods involve moving the areola and nipple, which are attached to a wedge of tissue called the "pedicle" that contains the milk sinuses. The stalks remain attached to the ducts, which connect to the mammary sinuses as well as the primary nerves.

The risk of lactation failure increases with periareolar incisions, which increase the likelihood of separation of the milk ducts.

However, some lactation opportunities remain due to the miraculous process of recanalization. There are cases where women with completely removed nipples and areolas released colostrum during pregnancy. However, recanalization fails to ensure sufficient milk production because the severed nerves do not activate the lactation system in response to stimulation of the nipple and areola nerves. Colostrum production is not dependent on nipple stimulation.

Length of time between surgery and pregnancy

The next important factor affecting the amount of milk is the period of time between mammoplasty and subsequent pregnancy. Physiological processes contribute to the restoration and development of the milk system.

These processes are recanalization and reinnervation (regeneration of ducts and nerve pathways, respectively), which take time. Both processes are directly responsible for increasing milk supply. The third process is the normal progressive development of the milk system.

Recanalization is a process in which breast tissue re-forms previously cut ducts. Completely new pathways can be formed to transport milk from the glands to the nipple. The process is not well understood enough for clinicians to be able to predict to what extent recanalization may occur. In some patients, recanalization led to a complete supply of milk to the children. As a general rule, the greater the experience of lactation, the greater the degree of recanalization that will occur.

Reinnervation occurs over time due to the body's normal regeneration process, and is not related to the experience of previous lactation. Reinnervation is the process by which the nipple and areola nerves damaged by surgery are restored. The nerves of the nipple and areola are critical to the lactation process, so regeneration of such nerves increases the ability of lactation.

The effect of implants on breastfeeding

Scientists are confident that breast implants are safe and do not affect pregnancy or reduce a woman's ability to breastfeed after childbirth. Despite this, many women decide to postpone surgery until after the baby is born.

Research has been conducted into the potential for silicon to pass into breast milk due to possible leakage from silicone implants. No difference was found in the composition of breast milk between women with and without implants. None of the types of breast implants affect the composition of breast milk or pose any threat to the health of the child.

Moreover, studies examining the relationship between the incidence of birth defects in fetuses of mothers with and without implants have demonstrated the safety of silicone implants.

Breast implants do not interfere with healthy breastfeeding.

However, if the implants are damaged, leaking or ruptured, the implant must be removed immediately.

Some scientists suggest that the pressure exerted by the implant may be harmful to milk production. Increased pressure inside the gland can lead to a reduction in milk production. In this case, the location of the implant is important. Implants in the axillary position place less pressure on the glandular tissue and do not interfere with its function.

The incisions made to place implants typically cause some damage to the nerves in the area surrounding the nipple and the glandular tissue. When the surgery is performed with incisions in the armpit or under the breast crease, most women have no problems breastfeeding. The most common method is to make incisions around the areola, which often results in nerve damage.

The likelihood of repeat mammoplasty after breastfeeding

If mammoplasty was performed before pregnancy, after pregnancy the breasts may fall under the weight of the implant and will look unnatural. Patients should be aware that their breasts will change to some extent (sagging, loss of volume, stretch marks), and the presence of implants may make the situation worse.

During pregnancy, intense changes occur in the female body. Breasts increase in volume due to the growth of breast tissue and increased blood flow. These changes occur as a result of a hormonal surge. Pregnancy affects both natural breasts and breasts augmented with implants in the same way. The range of changes varies from person to person, but almost always during pregnancy and lactation the breasts are larger and fuller than before pregnancy.

Most women are unhappy with the size and shape of their breasts. The desire to become attractive and confident does not depend on age. Everyone wants to become beautiful and spectacular!

A separate group of patients at plastic clinics are women after childbirth and breastfeeding. They complain that the breasts have lost their previous shape, become less firm, and white stretch marks have appeared on the skin. This is a fairly common problem, so women turn to surgeons for help.

Important: Mammoplasty after pregnancy will help restore inner confidence and former attractiveness. Mammoplasty after childbirth will immediately solve several problems, for example, nipple deformation and ptosis of the mammary gland. All of these issues should be discussed in detail with a trusted professional.

How long after giving birth can mammoplasty be done?

This is perhaps the most common question among clients of plastic clinics. It is important to choose the timing of the operation correctly. According to experts, complete restoration of the mammary gland and its involution (reverse development) occurs within 8-9 months after stopping breastfeeding. Around this time, you can start going to consultations and choose a method to solve the problem that has arisen.

Remember: If you do mammoplasty after pregnancy at earlier stages, you may not achieve the desired result! Carrying a baby and breastfeeding are the strictest contraindications for such manipulations. You should not trust specialists who neglect these simple rules.

But what to do if a woman refuses to breastfeed? In such cases, of course, there is no need to wait such a long period. During the consultation, an experienced plastic surgeon will independently select the optimal timing of the intervention, based on the individual characteristics of the patient’s body.

Indications for breast surgery after childbirth

After childbirth it will help solve the problem:

Flattening of the breast. This happens when the shape of the mammary gland does not change, and the breast itself becomes “empty”.
Ptosis or sagging gland.
Excessive increase in size with the appearance of stretch marks.
Asymmetry of the mammary glands.

Such problems mainly occur in women with a high body mass index or overweight. If the size of the gland increases too much during pregnancy, it may sag or become flattened. Mammoplasty after childbirth may be necessary for a woman who is not used to regular exercise. After all, without optimal loads, the skin loses firmness and elasticity.

Experts recommend that during pregnancy you monitor the quality of your underwear and its compliance with your new body size. Also, careful weight gain and the absence of fast carbohydrates in the menu will be a good prevention of sagging and unsightly breasts.

Physical exercises appropriate to the trimester of pregnancy will help keep your skin and muscles toned. And it will be much easier to recover after the birth itself.

The possibilities of mammoplasty allow you to adjust the shape or size of the breast, giving it aesthetics and special attractiveness. Wanting to become beautiful, many young women who decide to undergo surgery do not think about how it affects future pregnancy and lactation. How compatible mammoplasty and breastfeeding becomes important for a woman who has undergone endoprosthetics at the moment when she plans to have a child. As a rule, breastfeeding does not conflict with mammoplasty and they can be combined.

The most common problems during breastfeeding that a woman who has undergone mammoplasty may encounter are no different from the difficulties of all mothers during this period:

insufficient lactation - the volume of milk produced by the glands does not depend on the presence or absence of implants. It can be increased through nutrition and frequent breastfeeding. Taking a warm shower before feeding and performing a light massage also promotes lactation;
the appearance of cracks in the nipples, which can be avoided by maintaining hygiene and using special nipple covers;
excessive lactation, which can be adjusted by refusing additional pumping;
the need to wear special bras.

Due to the high morbidity, breast reduction surgery is especially dangerous for women who have not given birth. During such a surgical intervention, injury to the lobules of the mammary glands and ducts occurs, leading to lactation dysfunction.

Mammoplasty is contraindicated for women before childbirth if there is inflammation in the mammary glands, for example, mastitis or diseases that can lead to complications. These include mastopathy, fibroadenoma, and malignant tumors. In this case, breast enlargement surgery is possible only 1-2 years after undergoing appropriate treatment, and only if there are no relapses.

To avoid difficulties with breastfeeding, it is necessary to discuss this issue with a plastic surgeon before the birth of the child. This issue should be taken into account when planning any type of mammoplasty. It is especially important for breast reduction and operations in the area of the nipples and areola.

Endoprosthetics and breastfeeding

Combining pregnancy and mammoplasty surgery is impossible - any correction of the mammary glands is carried out before or after. If a woman had mammoplasty before pregnancy, it is usually recommended to postpone pregnancy planning for a year. This will allow the breast tissue to fully recover after endoprosthetics and form a protective capsule. If pregnancy occurs earlier, then to prevent unwanted changes, a woman must wear a support bra. By the time of birth, the mammary gland tissue will be completely restored, perhaps with the exception of small scars at the site of the incision. During pregnancy, you should visit your doctor regularly and undergo proper check-ups.

The presence of breast implants also does not affect the ability to pump. In this case, special devices for pumping can be used. They are designed in such a way that when affecting the mammary glands, they do not involve implants.

Do implants affect breastfeeding?

The results of scientific studies prove that breast implants do not affect the development of pregnancy and the ability to breastfeed a baby. In the event of damage resulting in leakage of their contents, the chemical composition of breast milk remains unchanged, since the silicone gel does not penetrate into the vessels and does not mix with milk, but the implants themselves must be removed immediately.

Confirmation of the complete safety of endoprosthetics for pregnancy and breastfeeding is the fact that the frequency of congenital pathologies in infants does not depend on whether the mother has breast implants or not

Pregnancy after mammoplasty in some cases can provoke the appearance of swelling and pain, the formation of inflammation in the tissues. If such symptoms appear, you should immediately consult a doctor.

Do implants affect lactation?

None of the implants currently practiced in endoprosthetics affects the ability of the mammary glands to produce milk, does not change its composition and does not pose a threat to the health of the newborn.

However, it is believed that certain placement of the implant can put pressure on the mammary glands, increasing the pressure inside them and reducing the amount of milk produced. The problem of breastfeeding will not arise if, during breast augmentation, an incision was made in the armpit area (the so-called transaxillary method of implant installation) or it was performed in the inframammary fold. Placing an endoprosthesis using the periareolar method (an incision is made along the areola) can cause damage to the nerve endings in the area around the nipple.

The mammary glands are subject to the least pressure if the endoprostheses are located in the axillary position

When installing an implant using the periareolar method or performing corrective surgery in the nipple-areolar region, performing the lactation function becomes impossible, therefore, even before the operation begins, the patient must notify the patient about this and, if possible, choose a different method of endoprosthetics.

Reduction plastic surgery can have a significant impact on the lactation process, since surgical reduction in the breast leads to damage to the milk ducts and their inability to perform their functions. The periareolar method of endoprosthetics also leads to damage to the tactile nerves, which in turn affects the lactation process and also increases the risk of mastitis.

How to care for your breasts during breastfeeding if they have implants

Breasts after mammoplasty during pregnancy and breastfeeding require careful care:

adherence to a lactation-stimulating diet;
daily taking a contrast shower and doing gymnastics;
the use of special cosmetics to prevent stretch marks.

The presence of breast implants does not cause the development of mastitis during lactation. However, insufficient pumping at the initial stage of lactation can become the root cause of lactostasis - stagnation of milk in the glands, leading to inflammatory processes. Compliance with feeding techniques and special massage will serve as the best prevention of this phenomenon.

Do I need to change implants after the birth of a child?

Pregnancy leads to transformations in the female body, including breast changes. It increases in size regardless of whether implants were installed before pregnancy or not, and the degree of increase depends on the individual characteristics of the woman. Pregnancy and lactation do not affect the endoprostheses themselves - they remain unchanged throughout the entire period, only the breast tissue changes. At the end of lactation, the breasts usually decrease in size and return to their original size, although they may sag under the weight of the implants. In some cases, if the skin is thin and the tissues are weak, after feeding the bust can lose its shape and elasticity and sag. This effect will be even more pronounced if the implants are initially placed low or in a subglandular position. In this case, the woman will need a breast lift or repeat mammoplasty after childbirth, which involves replacing the implants with others that are more consistent with the changed anatomy.

A course of special massage, gymnastics and water procedures, and the use of cosmetics with a lifting effect will help restore breast elasticity with slight sagging. They are applied to the skin of the breast, avoiding the area of the areola and nipple.

Mastopexy and breastfeeding

As is known, lactation does not affect the development of breast ptosis. Sagging after breastfeeding is most likely caused by hormonal and anatomical changes in the body, which can be corrected with a breast lift, called mastopexy. During this procedure, the plastic surgeon removes only the skin, without affecting the glandular tissue of the breast, milk ducts and nerves located around the nipples. This lift only affects the shape of the breast, thus fully preserving the ability to lactation.

The tightening effect achieved as a result of mastopexy is temporary. After a few years, it may need to be repeated.

Is it possible to perform mammoplasty after breastfeeding and when?

Breast augmentation surgery can be performed as early as 6 months after pregnancy, but provided that you are not breastfeeding. Otherwise, this can only be done 6-8 months after the end of lactation. More specific dates are determined by the doctor individually, after undergoing an ultrasound of the mammary glands. Carrying out endoprosthetics before the milk ducts have been reduced can cause complications that require treatment, for example, the accumulation of secretions and the formation of seromas in the cavities, and the development of inflammatory processes.

The combination of mammoplasty and breastfeeding is quite possible if the operations performed were aimed at breast lift or its correction using endoprosthetics. Operations performed in the area of the nipples and areola, as well as those aimed at breast reduction, remain incompatible with breastfeeding. In any case, women of childbearing age are recommended to coordinate the planned pregnancy with a plastic surgeon before undergoing surgery so that he can take this into account when planning it. The best option would be to perform mammoplasty after the birth of the child.

Breast augmentation surgery with implants is becoming increasingly common. Women of the childbearing period strive to improve their external appearance. Mass expansion is possible with the help of silicone implants placed above or below the inframammary muscle.

Mammoplasty before birth possible one year before implementation. This time is required for complete recovery after surgery.

Changes will occur during pregnancy, so it is not advisable to make corrections during this period.

If a young mother decides to improve her external parameters, then mammoplasty after childbirth recommended three months after breastfeeding ends.

You should wear a special bra that will provide support. It is important when pregnancy after mammoplasty. The situation is not something terrible, complete healing will occur by the time of delivery, only small scars will remain in the area of the incisions.

When consulting, a plastic surgeon usually warns that this procedure will affect the implementation of lactation. The mammary glands have multiple ducts. The original part will probably not change. Some people affected by surgery are able to recover. In practice it is clear that feeding after mammoplasty is a real event. Only when significant parts are subjected to surgical violations will the amount of contents be insufficient.

Factors determining the condition of the mammary gland

Let's name some indicators:

Operation type. It is important to preserve as much tissue as possible. Lactation is preserved when the nipples and areolas are partially operated. In this case, their movement is possible. Insufficiency of milk will be with periareolar incisions, increasing the separation of the ducts.

Temporal distance between pregnancy and surgery. Physical phenomena play an important role in the renewal and development of the dairy system. They are:

Implants. None of their types affects the milk content in the glands and is not a danger to the baby’s health. Special studies organized to study this issue indicate the reliability of the application.

That's why, mammoplasty and feeding completely compatible processes.

It should be noted that in case of damage, ruptures and leakage occur. Then the implant is immediately removed.

Repeated surgery after breastfeeding

If the intervention took place before pregnancy, then afterward, under the weight of the implant, the breasts may sag and take on a not very attractive appearance. Patients should be aware that their appearance will change. Stretch marks, drooping, and loss of shape will appear. Implantations will worsen the situation.

During pregnancy, the body undergoes significant transformations. An increase occurs due to the growth of breast tissue and expansion of blood flow. This is the result of a rise in hormones. Pregnancy has the same effect on natural breasts and those enhanced by implants. All changes are individual, but in most cases, a pregnant or nursing mother has fuller volumes than before this period. The implants will remain unchanged.

After feeding, the previous size may return. Sometimes there is significant sagging and loss of shape. This effect is emphasized by the fact that the implants are placed very low.