To the Editor:
The number of breast reduction and augmentation mammaplasties is increasing today. Many women undergo these operations before or during their childbearing period, leading to the question of possible consequences for breastfeeding ability. Mammaplasties of both types are performed for cosmetic reasons. Reduction surgery is also performed for medical reasons such as headache, neck and shoulder pain, numbness in hands, breast pain and intertrigo;1 studies show diminished bodily pain and improved overall health-related quality of life after reduction mammaplasty. 1,2 Silicone implants with silicone or saline filling are typically used today in augmentation mammaplasty. 3
Breastfeeding after reduction and augmentation mammaplasties has received little attention in the literature. Widdice 4 presented estimates of the proportion of women who were able to lactate after breast reduction ranging from 0% to 70%, depending on the type of reduction surgery, and stated that women were often able to breastfeed after breast augmentation surgery. Effects of breast surgery on breastfeeding may in turn have health effects.
In a recent Cochrane Review, Kramer and Kakuma 5 concluded that the health benefits of exclusive breastfeeding during the first 6 months exceeded those with mixed breastfeeding. Hanson et al. 6 pointed out a number of immunologically beneficial effects of breastfeeding. The milk secretory IgA antibodies stop microbes on the mucosa, preventing infection. In addition, the milk contains many protective factors functioning as analogues for microbial receptors. As a result, breastfeeding substantially reduces the risk of several types of infections, and it seems that human milk can actively stimulate the immune system of the breastfed infant.
Breastfeeding may also have positive health effects for the mother. A recent article presented a detailed reanalysis of 47 published studies, with nearly 150,000 participants from 30 countries, showing that breastfeeding reduces a woman's risk of breast cancer and that the longer women breastfeed, the more they are protected against breast cancer. 7
In an examination of the literature in this area (table) we found that the frequency of women who breastfed after breast surgery ranged widely—from 19% to 82% after reduction mammaplasty 8,9 and from 36% to 85% after augmentation mammaplasty. 10,11 However, comparisons among the studies are complicated by small study populations and various surgical techniques, as well as possible interviewer and recall bias. One of the major problems in interpreting these studies is that the type of breastfeeding (ie, whether it is exclusive or partial) is seldom defined. Some of these studies provided definitions of exclusive and partial breastfeeding, 8,10,13,14 although the definitions were not uniform. Many studies defined breastfeeding dichotomously (“yes or no”) without any information on whether the breastfeeding was exclusive or partial, nor the duration of breastfeeding. 11,12,15–19
It is important that studies of the relation between mammaplasty and breastfeeding be conducted because of statements in literature about reduced lactation ability. 18 To improve comparability, future studies should include clear statements of the surgical methods used and possible modifications. Assessment of breastfeeding should preferably conform to the definition by the World Health Organization, 19 and the duration of breastfeeding needs to be considered.
Åsa S. Johansson
1. Chadbourne EB, Zhang S, Gordon MJ, et al
. Clinical outcomes in reduction mammaplasty: a systematic review and meta-analysis of published studies. Mayo Clin Proc 2001; 76: 503–510.
2. Blomqvist L, Eriksson A, Brandberg Y. Reduction mammaplasty provides long-term improvement in health status and quality of life. Plast Reconstr Surg 2000; 106: 991–997.
3. Beekman WH, Hage JJ, Jorna LB, Mulder JW. Augmentation mammaplasty: the story before the silicone bag prosthesis. Ann Plast Surg 1999; 43: 446–451.
4. Widdice L. The effects of breast reduction and breast augmentation surgery on lactation: an annotated bibliography. J Hum Lact 1993; 9: 161–167.
5. Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev 2002: CD003517.
6. Hanson LA, Korotkova M, Haversen L, et al
. Breast-feeding, a complex support system for the offspring. Pediatr Int 2002; 44: 347–352.
7. Beral V. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet 2002; 360: 187–195.
8. Brzozowski D, Niessen M, Evans HB, Hurst LN. Breast-feeding after inferior pedicle reduction mammaplasty. Plast Reconstr Surg 2000; 105: 530–534.
9. Aboudib JHJ, de Castro CC, Coelho RS, Cupello AM. Analysis of late results in postpregnancy mammoplasty. Ann Plast Surg 1991; 26: 111–116.
10. Hurst NM. Lactation after augmentation mammoplasty. Obstet Gynecol 1996; 87: 30–34.
11. Fryzek JP, Weiderpass E, Signorello LB, et al
. Characteristics of women with cosmetic breast augmentation surgery compared with breast reduction surgery patients and women in the general population of Sweden. Ann Plast Surg 2000; 45: 349–356.
12. Strom SS, Baldwin BJ, Sigurdson AJ, Schusterman MA. Cosmetic saline breast implants: a survey of satisfaction, breast-feeding experience, cancer screening, and health. Plast Reconstr Surg 1997; 100: 1553–1557.
13. Harris L, Morris SF, Freiberg A. Is breast feeding possible after reduction mammaplasty? Plast Reconstr Surg 1992; 89: 836–839.
14. Marshall DR, Callan PP, Nicholson W. Breastfeeding after reduction mammaplasty. Br J Plast Surg 1994; 47: 167–169.
15. Deutinger M, Deutinger J. Breast feeding after aesthetic mammary operations and cardiac operations through horizontal submammary skin incision. Surg Gynecol Obstet 1993; 176: 267–270.
16. Cook LS, Daling JR, Voigt LF, et al. Characteristics of women with and without breast augmentation. JAMA 1997; 277: 1612–1617.
17. Aillet S, Watier E, Chevrier S, Pailheret JP, Grall JY. Breast feeding after reduction mammaplasty performed during adolescence. Eur J Obstet Gynecol Reprod Biol 2002; 101: 79–82.
18. Neifert M. Breastfeeding after breast surgical procedure or breast cancer. NAACOGS Clin Issu Perinat Womens Health Nurs 1992; 3: 673–682.
19. WHO. Infant and young child nutrition, WHA54.2. World Health Organization Web site.
Available at: http://www.who.int/gb/EB_WHA/PDF/WHA54/ea54r2.pdf
. Accessed 3 July 2002.