The great majority do breastfeed, although the rate is somewhat lower than without surgery: 82.25% of 9,965 women with implants managed it, against 88.45% of 388,695 without them (Chen et al., Aesthet Surg J 2023).
What matters is not the implant but the route in and where it is placed: the inframammary fold is the most conservative approach and the armpit barely interferes; the areolar route is the one that can most affect the milk ducts. In Hurst’s classic series of 42 women who had surgery, the periareolar route was the one most associated with insufficient lactation (Hurst, Obstet Gynecol 1996).
The submuscular or dual plane is considered safer for breastfeeding than the subglandular one, because it sits further from the tissue that produces the milk.
Neither the material nor a rupture alters the milk: the silicon measured in the milk of women with implants is no different from that of women without them (55.45 against 51.05 ng/ml) and is far below that of cow’s milk (709 ng/ml) and infant formula (4,402 ng/ml) (Semple et al., Plast Reconstr Surg 1998).
Surgery is not carried out during breastfeeding: you have to wait about 3 months after weaning for the breast to regain its final volume. And a later pregnancy can change the result and call for revision surgery.
One of the questions women most often raise in consultation before having a breast augmentation is whether they will be able to breastfeed in future. The relationship between augmentation mammoplasty and breastfeeding gives rise to understandable doubts, especially among young women or women of childbearing age who have not yet had children.
The reality is that most women can breastfeed after a breast augmentation, provided the surgery has respected the anatomical structures involved in lactation. In this article we answer, clearly and professionally, all the questions surrounding breast augmentation and motherhood.
If you are still weighing up surgery, the guide to breast augmentation sums up what it involves before we turn to the chapter on breastfeeding.
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To understand the relationship between breast augmentation and breastfeeding, it helps to know the key structures involved in producing and carrying breast milk:
Mammary gland: produces the milk under the stimulus of hormones such as prolactin and oxytocin.
Milk ducts: carry the milk from the gland to the nipple.
Nipple-areola complex: allows the milk out through suckling.
A well-planned breast augmentation should not interfere with these structures, especially where conservative surgical approaches are used and the implant is placed in planes away from the glandular tissue.
How does the type of surgery affect breastfeeding?
The impact on breastfeeding does not depend on the implant itself but on how and through where it has been placed. Several factors determine whether breast function is preserved.
1. Surgical route in
Inframammary fold: the incision is made in the crease under the breast, away from the areola and from the path of the main ducts.
Armpit: takes the operation even further from the gland and the nipple-areola complex.
Areolar: the route that passes closest to the milk ducts, which is why it is credited with the greatest potential to interfere.
It is worth saying that this ranking is anatomical, not demonstrated. The meta-analysis that compared the routes found the estimate for the periareolar route too imprecise to conclude anything (RR 0.32; 95% CI 0.04–2.51), and that the one which did show a statistically significant reduction in exclusive breastfeeding was the inframammary fold (RR 0.61; 95% CI 0.46–0.82) — probably because it is the most used route and the one contributing most data. On today’s published evidence, choosing the route with breastfeeding alone in mind is not justified.
2. The plane the implant is placed in
Subglandular: placed between the gland and the muscle. It sits closer to the tissue responsible for producing milk, although it does not damage it directly when the technique is correct.
Submuscular (or dual plane): the implant is placed under the pectoral muscle. This technique is considered safer as regards breastfeeding, since it does not interfere with the gland or the ducts.
The implant sits behind the gland, in a different plane from the tissue that produces the milk, whether it goes under the muscle or in front of it. The route in is a decision with consequences, and it is the one discussed before operating.
What do the medical studies say?
The current scientific evidence indicates that most women who have had a breast augmentation keep their ability to breastfeed. That said, the proportion is somewhat lower than in women who have not had surgery, and it is worth saying so with the figures to hand. The largest meta-analysis published to date brought together 9,965 women with implants and 388,695 without them: 82.25% of the first group breastfed successfully against 88.45% of the second (pooled odds ratio 0.45; 95% CI 0.38–0.53) (Chen et al., Aesthetic Surgery Journal, 2023).
It is important to remember that many women who have not had surgery also have difficulties with breastfeeding, for anatomical or hormonal reasons or reasons to do with the baby. Every difficulty should not therefore be put down to breast surgery.
Do the type of implant or the material make a difference?
No. The type of implant (silicone or saline) does not affect the ability to breastfeed. Nor is there any evidence that breast milk is contaminated or altered by the presence of an implant, even in the event of a rupture.
The highly cohesive silicone gel used today in most implants is biocompatible and is held within a shell that does not release particles into the surrounding tissue.
What is more, implants are not placed inside the glandular tissue but underneath it, and they are completely isolated from the ducts and from the milk.
What happens if I become pregnant after surgery?
A pregnancy after a breast augmentation poses no risk to the surgery or to the health of the mother or the baby. It is important, however, to bear in mind that:
The hormonal change during pregnancy can cause the breasts to increase in size, affecting the aesthetic result of the operation.
After breastfeeding, slackness or loss of volume may appear, especially if the skin loses elasticity.
In some cases, where significant changes occur, revision surgery or a mastopexy (breast lift) may be advisable.
For that reason, in women who have not yet had children the surgeon must anticipate this possible scenario and choose both the type of implant and the surgical plane strategically.
Can a breast augmentation be done while breastfeeding?
No. A breast augmentation should not be carried out during breastfeeding or in the months immediately after weaning. It is necessary to wait around 3 months after breastfeeding ends for the mammary gland to regain its final volume and shape.
Operating before that period can lead to unstable results, a higher risk of complications and less precision in planning the surgery.
How can I know whether I will be able to breastfeed after a breast augmentation?
During the consultation the surgeon carries out an individual assessment of your anatomy and your history. If you have not yet had children and wish to preserve your ability to breastfeed, it is possible to:
Choose a conservative route in, such as the inframammary fold.
Use a submuscular plane that protects the gland.
Avoid unnecessary surgical manoeuvres on the nipple-areola complex.
Give you clear information about your options and the risks.
Yes, it is possible to breastfeed after an augmentation mammoplasty, provided the functional anatomy of the breast has been respected. The right surgical technique, the type of approach and the placement of the implant are decisive factors in ensuring compatibility with breastfeeding.
If you are considering a breast augmentation and have not yet had children, it is essential that you raise this question at the first consultation. At our clinic we will help you choose the technique that is safest for you, without compromising either your plans for motherhood or your aesthetic results.
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Will I be able to breastfeed after a breast augmentation?
The great majority can, although the rate is somewhat lower than without surgery. The largest meta-analysis published brought together 9,965 women with implants and 388,695 without them: 82.25% of the first group breastfed successfully against 88.45% of the second.
What matters more, the implant or the technique?
Not the implant, but the route in and where it is placed. The inframammary fold is the most conservative approach and the armpit barely interferes; the areolar route passes closest to the milk ducts. And the submuscular or dual plane is considered safer than the subglandular one, because it sits further from the tissue that produces the milk.
So should the periareolar route be avoided if I want to breastfeed?
On today’s published evidence, choosing the route with breastfeeding alone in mind is not justified. The meta-analysis that compared the routes found the estimate for the periareolar one too imprecise to conclude anything (RR 0.32; 95% CI 0.04–2.51), and the one that did show a significant reduction in exclusive breastfeeding was the inframammary fold (RR 0.61), probably because it is the most used. The anatomical ranking is reasonable, but it is not demonstrated.
Is the milk affected by the implant, even if it ruptures?
No. Neither the material nor a rupture alters the milk. The silicon measured in the milk of women with implants is no different from that of women without them (55.45 against 51.05 ng/ml) and is far below that of cow’s milk (709 ng/ml) and infant formula (4,402 ng/ml). What is more, implants are not placed inside the glandular tissue but underneath it, isolated from the ducts.
Can surgery be done while breastfeeding?
No. It should not be carried out during breastfeeding or in the months immediately after weaning. You have to wait around 3 months after it ends for the gland to regain its final volume and shape; operating earlier leads to unstable results, a higher risk of complications and less precision in planning.
What if I become pregnant after surgery?
A later pregnancy poses no risk to the surgery or to the health of the mother or the baby. But it is worth knowing that the hormonal change can increase the size of the breasts and affect the aesthetic result, that slackness or loss of volume may appear after breastfeeding, and that in some cases revision surgery or a mastopexy may be advisable.
If I have not had children yet, what can be done to preserve breastfeeding?
Choose a conservative route in such as the inframammary fold, use a submuscular plane that protects the gland, avoid unnecessary surgical manoeuvres on the nipple-areola complex, and get clear information about the options and the risks. It is essential to raise this at the first consultation.
If I have difficulty breastfeeding, will it be because of the surgery?
Not necessarily. Many women who have not had surgery also have difficulties with breastfeeding, for anatomical or hormonal reasons or reasons to do with the baby. Every difficulty should not be put down to breast surgery.
Sources
Chen J, Zhu XM, Huynh MNQ, McRae M.Breastfeeding Outcome and Complications in Females With Breast Implants: A Systematic Review and Meta-Analysis. Aesthet Surg J. 2023;43(7):731-740. PMID 36752943 — 82.25% of 9,965 women with implants breastfed against 88.45% of 388,695 without them (pooled odds ratio 0.45; 95% CI 0.38–0.53). Complications described: pain, mastitis, insufficient or excessive milk production and inverted nipple.
Schiff M, Algert CS, Ampt A, Sywak MS, Roberts CL.The impact of cosmetic breast implants on breastfeeding: a systematic review and meta-analysis. Int Breastfeed J. 2014;9:17. PMID 25332722 — a reduction in exclusive breastfeeding (pooled RR 0.60; 95% CI 0.40–0.90) and the figures by surgical route quoted above.
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