There are two main types of breast surgery that women undergo: implants and breast reduction. These are very different procedures and are carried out for differing reasons, so we will look at each separately as to their potential impact on breastfeeding.

Please note that this is general advice and should not be taken as medical advice. As always, please speak to your healthcare provider regarding your specific situation.

Breast Implants

This is one of the most common plastic surgery procedures, and so more and more women are concerned with the implications for their future (or current) breastfeeding relationship. There are many factors that affect the outcome from a breastfeeding perspective, and so we’ll look at each in turn.

Breast development prior to surgery. When the cosmetic procedure is done to correct abnormal breast development, there may be an underlying issue with the available functional tissue for breast development. Breast types that are commonly associated with these issues are tubular breasts, widely spaced breasts (approx. hand width between breasts), asymmetrical breasts, and underdeveloped breasts. Not every woman with these anatomical features will struggle to make enough milk, but they are markers to be aware of. In these cases, it is not the surgery itself that causes the issues, but rather the reason the surgery was undertaken in the first place.

Location of the surgical incision. The position of the incision made by the surgeon can have implications for breastfeeding. For example, incisions around the areola more commonly cause nerve damage that can affect breastfeeding. In general, we are concerned regarding nerve damage, damage to the milk glands and ducts, and damage to the blood supply to the breast or nipple.

Type of procedure. There are a few different procedures commonly used to insert breast implants, and some do less damage to the functional breast than others. For example, inframammary (under the breast) and axillary (in the armpit) procedures don’t damage the milk ducts or nerves and so have less impact on breastfeeding. However, periareolar (around the nipple) and transumbilical (through the belly button) can cause more damage. One study showed that women who underwent the periareolar procedure were five times more likely to have breastfeeding challenges.

Other issues. Nipple sensitivity can change following surgery. If you are now more sensitive than before, you may find breastfeeding challenging, even with a good latch. A loss of sensitivity can impair the letdown, making the release of milk more challenging. In addition, scar tissue can extend into the milk ducts, making the release of milk more difficult from certain areas, which can lead to engorgement and other complications.

Breast reduction surgery

Many women undergo breast reduction surgery due to the physical difficulties of large breasts, which may have been causing backaches and other pains. This type of surgery inevitably damages the breast tissue and can cause more issues than implants. Again, there are a couple of factors that influence the damage.

The surgical procedure is done. These days, most surgeons try to avoid complete removal of the nipple-areola complex in order to better preserve the ability to breastfeed. However, there will be damage and severance of at least some of the milk ducts (tubes through which milk flows from milk-making tissue to the nipple) in surgery. The removal of the nipple-areola complex will sever all these ducts and make breastfeeding more challenging.

Time since surgery. In some cases, the milk ducts can reattach, allowing milk to flow again. This was more likely when surgery occurred several years ago. One known complication of surgery is that the milk-making tissue may have been preserved, but the ducts were severed. This will result in severe engorgement in the early days as milk production ‘kicks in’, but has nowhere to go. You may find your breasts feeling full of milk, but there appears to be no active sucking by the baby, or no milk comes when pumping. In these cases, unfortunately, breastfeeding isn’t possible, and it’s best to consult with your medical team about safely stopping milk production. In other cases, you may find that some milk flow occurs, but you get localised engorgement in certain areas of the breast. This can occur when there is partial reattachment of the milk ducts. Here, we would manage the breasts so that production shuts down in the affected areas while continuing to breastfeed with the remaining supply.

So, can you still breastfeed after surgery?

It’s impossible to know ahead of time if you will be able to make a full milk supply, but most mothers will be able to at least partially breastfeed. In complex cases like these, it’s best to have support in place from the beginning to maximise the breastfeeding management aspects of breastfeeding for the best possible outcome. It is also important to keep a keen eye on the baby for signs of sufficient intake.

In general, some healing will occur from any damage caused, and as such, the further you are from your surgery, the greater your chances of being able to breastfeed successfully.

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