Breast surgery after pregnancy and breastfeeding: timing, future breastfeeding and when it is better to wait

“My breasts were left empty and dropped after I breastfed” is one of the sentences most often heard in a breast surgery consultation. And it almost always comes with a guilt that is worth defusing first: the suspicion that breastfeeding was what spoiled them.

This page answers that with what the evidence says —which agrees with itself rather less than it is usually made out to—, and then answers the two calendar questions that really matter: how long to wait and whether to have surgery before or after finishing having children.

First of all: it was not the breastfeeding (probably)

This section exists to lift a very widespread guilt, and it is worth setting out as precisely as possible, because the easy answer would be more categorical than the evidence allows.

The study that established the idea. In 2008 an analysis of 93 patients was published looking for the risk factors for the breast dropping after pregnancy. It identified as significant independent predictors: greater age, a higher body mass index, a greater number of pregnancies, a larger bra size before pregnancy and smoking. And its conclusion about breastfeeding was explicit: nursing does not appear to make those effects worse.

That same group published two years later a review of 132 patients assessing a lift or an augmentation, with consistent results: significant risk factors for ptosis were age, a history of substantial weight loss —more than 50 pounds, some 23 kilos—, a higher body mass index, a larger bra size, the number of pregnancies and smoking.

⚠️ And now the honesty that almost nobody adds. A prospective study published in 2017 on 605 women found the opposite on that particular point: postmenopausal status, a higher body mass index and breastfeeding for more than six months were independent risk factors both for greater breast volume and for ptosis. The incidence of ptosis in that series was 22.8%.

🔑 How to read this without misleading anyone. “Breastfeeding does not spoil the breasts” is repeated as an established fact and it is not one: there is at least one large study that contradicts it, in a different population and with a different methodology. What does hold up in both pieces of work is that pregnancy itself, the number of pregnancies and weight count for more than breastfeeding. And from that comes the useful conclusion: not breastfeeding would not have spared you the change.

What exactly has happened to your breasts

It is worth putting a name to it, because the operation that applies follows from that.

What usually remains after a pregnancy and a period of breastfeeding is a breast with two things at once:

It has lost volume at the top. The gland that grew during pregnancy and breastfeeding involutes afterwards, and the upper pole —the top part of the breast— is left empty. That is what makes the neckline “not fill”.

And it has descended. The skin stretched and does not always recover, so the contents drop and often the nipple with them.

⚠️ They are not the same problem and they are not corrected with the same thing. If the nipple has dropped below the inframammary fold, there is true ptosis and it has to be repositioned. If the nipple is still up and what has fallen is the tissue, it is pseudoptosis. The difference, with the criterion for measuring it, is in the grades of breast ptosis.

And on the missing volume: whether to restore it or not is a decision separate from the lift, and it is dealt with in the guide to breast lift without implants.

How long to wait

Here what can be stated has to be separated from what cannot.

What can be stated. That operating on a breast that is still changing is operating on a moving target. After breastfeeding ends the breast goes on involuting for a time, and body weight usually goes on moving too.

What there is not. A published interval. There is no validated figure for “X months after the last feed”. The ones that circulate on the internet are each surgeon’s own criterion, not the results of studies — and it is as well that whoever gives you one should tell you where it comes from.

The two reasonable criteria, which can be justified:

• That the breast has gone some time without changing. If it is still shrinking month by month, not yet.
• That your weight is stable. Breast volume follows body weight fairly predictably, so operating in the middle of a change in weight compromises the result. It is set out in full in empty, dropped breasts after weight loss.

The interval at this practice is 4 months from the end of breastfeeding. It does not come from a study —there is none— but from the clinic’s own criterion, and it answers exactly to what is above: it is the time the breast is given to stop changing.

🔑 On weight, the recommendation comes with its reason. It is advisable to arrive at surgery with a stable weight, because losing weight after the operation can make the result worse: the breast empties inside skin that has already been adjusted. It is the same reason it is asked for in the rest of breast surgery.

Before or after having more children?

It is the calendar decision that goes wrong most often, and the reference literature is unusually clear about it.

The published recommendation is to postpone surgery if pregnancies are planned. It appears expressly in the standard reference on breast lift surgery, and it is not a generic caution: it has two concrete reasons.

Reason 1: the result. A later pregnancy makes the breast grow again and then it involutes once more. The breast that was lifted can descend again, and that recurrence of ptosis is among the described complications of the procedure.

Reason 2: breastfeeding. On this one has to be precise, because it is put wrongly in both directions.

• A breast lift does not cut the nipple off: the nipple-areola complex travels on its pedicle, which preserves its blood supply and a good part of its connections. That is why breastfeeding is still possible in many cases.
• But it cannot be guaranteed. No surgery on the breast can promise a function that depends on ducts and glandular tissue that are handled.

🔑 The honest conclusion: if you plan to have children, the published recommendation is to wait, and anyone who tells you that having surgery now will have no consequence at all for future breastfeeding is promising you something they cannot know.

⚠️ And the qualification that makes it liveable: “wait” does not always mean wait. There are situations in which how you feel now weighs more than a hypothetical pregnancy ten years away. That is decided in consultation, with the information on the table — not with a rule from the internet.

And if I become pregnant after surgery

It happens, and it is not a catastrophe.

The breast will grow again with the pregnancy and involute afterwards, just as an unoperated breast would. What cannot be predicted is how it will end up: it may hold up reasonably well or it may descend again.

What does not happen is that the surgery “comes undone” or that there is any added risk to the pregnancy. How an operated breast ages, and what is done if it drops again, is in second breast lift.

Frequently asked questions

Is it normal for the breasts to be left empty and dropped after breastfeeding?

Yes, and it is usually down to two things at once: the gland that grew during pregnancy and breastfeeding involutes and leaves the upper pole empty, and the stretched skin does not always recover, so the contents descend.

Have my breasts dropped because I breastfed?

The reference study, with 93 patients, concluded that nursing does not appear to make the appearance of the breast worse: the independent factors were age, body mass index, the number of pregnancies, the previous bra size and smoking. It is worth knowing, however, that a later study in 605 women did associate breastfeeding for more than six months with ptosis. The literature does not agree, but in both cases pregnancy and weight count for more.

How long do you have to wait after breastfeeding before having surgery?

At this practice, 4 months from the end of breastfeeding. There is no interval published in the literature: it is the clinic’s own criterion, and it answers to the fact that the breast goes on changing during that time. To that is added arriving at a stable weight, because losing weight after the operation can make the result worse.

Is it worth having surgery before having children or is it better to wait?

The recommendation of the reference literature is to postpone surgery if pregnancies are planned, for two reasons: a later pregnancy can change the result, and no breast surgery can guarantee future breastfeeding. And that is exactly what is said here: ideally, have surgery afterwards. But the door is not closed — if you prefer to do it beforehand, it is done, in the knowledge that if the result worsens after a pregnancy options for secondary correction exist. The decision is yours, with that information in front of you.

Will I be able to breastfeed after a breast lift?

In many cases yes: the nipple keeps its pedicle, with its blood supply and a good part of its connections. But it cannot be guaranteed, and anyone who guarantees it is promising you something they cannot know.

What happens if I become pregnant after surgery?

The breast will grow with the pregnancy and involute afterwards, as an unoperated one would. There is no added risk to the pregnancy and the surgery does not come undone, but how the shape will end up cannot be predicted.

Will a breast lift give me back the volume I have lost?

No: a breast lift repositions the volume you have, it does not add any. Restoring volume is a separate decision, and the options are on the breast lift without implants page.

Sources

• Rinker B, et al. The effect of breastfeeding on breast aesthetics. Aesthet Surg J. 2008;28:534-537. Analysis of 93 patients on the risk factors for breast ptosis after pregnancy; significant independent risk factors were greater age, a higher body mass index, a greater number of pregnancies, a larger bra size before pregnancy and smoking; the authors’ conclusion about breastfeeding is that nursing does not appear to make those effects worse. https://pubmed.ncbi.nlm.nih.gov/19083576/
• Rinker B, et al. Breast ptosis: causes and cure. Ann Plast Surg. 2010;64:579-584. Review of 132 patients consulting about breast augmentation or a breast lift; significant risk factors for breast ptosis were age, a history of substantial weight loss (more than 50 pounds, some 23 kilos), a higher body mass index, a larger bra size, the number of pregnancies and a history of smoking. https://pubmed.ncbi.nlm.nih.gov/20354434/
• Huang NS, et al. A prospective study of breast anthropomorphic measurements, volume and ptosis in 605 Asian patients with breast cancer or benign breast disease. PLoS One. 2017;12:e0172122. Prospective study that collected fifteen breast parameters in 605 Chinese women; the mean breast volume was 340.0 ± 109.1 ml and the incidence of ptosis 22.8%; postmenopausal status, a higher body mass index and breastfeeding for more than six months turned out to be independent risk factors both for greater breast volume and for breast ptosis. https://pubmed.ncbi.nlm.nih.gov/28192525/
• Toomey AE, Cape JD. Mastopexy (Breast Lift). StatPearls, NCBI Bookshelf, updated December 2024. Mastopexy repositions the nipple-areola complex while preserving breast volume; among the described complications are altered sensation of the nipple-areola complex and recurrence of ptosis; express recommendation to postpone the operation if pregnancies are planned. https://www.ncbi.nlm.nih.gov/books/NBK610682/
• Martinez AA, Chung S. Breast Ptosis. StatPearls, NCBI Bookshelf, updated November 2023. Regnault’s classification according to the position of the nipple relative to the inframammary fold and definition of pseudoptosis —the nipple above or at the level of the fold, most of the breast below it and a nipple-to-fold distance often greater than 6 cm—; ptosis is commonly associated with ageing, macromastia, weight loss, pregnancy and hormonal changes. https://www.ncbi.nlm.nih.gov/books/NBK567792/
• Ockell J, et al. «Normal» breast dimensions in obese women — reference values and the effect of weight loss. J Plast Reconstr Aesthet Surg. 2024. One hundred and six women measured before and after gastric bypass; the percentage change of each breast measurement relative to the percentage change in body mass index turned out to be predictable: with a 20% reduction in BMI, breast volume falls by 25%, the sternal notch-to-nipple distance by 4% and ptosis by 20%. https://pubmed.ncbi.nlm.nih.gov/38810359/

Book your consultation

If you have got this far suspecting that breastfeeding spoiled your breasts, the most useful answer is not entirely reassuring but it is liberating: pregnancy, the number of pregnancies and weight count for more than breastfeeding, and not nursing would not have spared you the change.

And if you are deciding when, the two questions that order the calendar are: have my breasts stopped changing? and do I plan to have more children? With those two answers, the conversation in consultation is a great deal shorter.

Clinical confirmation by the surgeon

Dr Enrique Salmerón González

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624077

Dr Elena García Vilariño

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624503