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Breastfeeding After Cosmetic Breast Surgery Presented by Diana West, BA, IBCLC

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Breastfeeding After Cosmetic Breast Surgery Presented by Diana West, BA, IBCLC Breastfeeding After Cosmetic Breast Surgery Presented by Diana West, BA, IBCLC BREASTFEEDING AFTER COSMETIC BREAST SURGERY Augmentation Mammoplasty (Breast Implants) Presented by Reduction Diana West, BA, IBCLC Augmentation [email protected] Breast Augmentation History Breast Augmentation History 1885: First augmentation (injection of 1950s-1960s: 50,000 patient’s own fat) – poor results women received silicone injections 1889: Paraffin (wax) – disastrous results Developed 1900-1945: Many substances tried – awful results granulomas and 1945: Flap-based technique rotated patient’s hardening requiring mastectomy chest wall tissue into breast to increase volume – nope Breast Augmentation History Breast Implants 1961: 1992: Silicone implants removed from US market Dr. Frank Gerow squeezed plastic transfusion bag filled with blood due to safety concerns Thought it felt like a woman's breast 2006: Health Canada and FDA declared silicone Developed the first silicone gel implants made by Allergan and Mentor companies to breast implant with Dr. Thomas be safe Cronin for Dow Corning 2012: Sientra approved by FDA to manufacture of 1964: silicone implants Laboratoires Arion developed first saline breast implant Copyright © 2014 by Diana West, IBCLC 1 Breastfeeding After Cosmetic Breast Surgery Presented by Diana West, BA, IBCLC Breast Implants Incidence of Breast Augmentation Surgery 2001-2010: 2013: 290,224 women in the US MOST Poly Implant Prothèse popular (PIP) silicone implants cosmetic surgery Used industrial grade in 2013 silicone, not medical grade High rupture, inflammation, malignancies, hardening, death rates Dec 2011: France first country to recall PIP implants, file fraud suit Dec 2013: PIP owner/founder Jean-Claude Mas jailed and fined in France Many other criminal and civil suits pending “We all have things that we want to change Pervasive advertising about ourselves and for many women, this relates to the size, shape or position of their breasts. Considering how prominent the breasts are to a woman’s overall appearance, it is not surprising to learn that many women would like to increase the size of their breasts.” – Sydney Breast Enlargement & Cosmetic Surgery Teen More Teens Having Augmentations Augmentations Teens increasingly 9000 requesting breast 8000 8204 implants as birthday, 7000 holiday, and 6000 graduation gifts 5000 4000 American Society of 3000 Plastic Surgeons 2000 (ASPS) FDA, and Health 1000 1396 Canada strongly recommend 0 against breast implants under 18 1997 2012 Copyright © 2014 by Diana West, IBCLC 2 Breastfeeding After Cosmetic Breast Surgery Presented by Diana West, BA, IBCLC Breast Augmentations by Age Teen Augmentations 53% to correct breast abnormalities 22% Tubular breast 17% Severe breast asymmetry 9% Congenital micromastia (severe underdevelopment) 5% Poland's syndrome (congenital absent breast) Why Breast Physical Reasons for Breast Augmentation Surgery? Augmentation Surgery Physical discomfort Reduction in breast volume after Psychological discomfort Weight loss Weight loss surgery Pregnancy Normal aging Physical Reasons for Breast Psychological Reasons for Augmentation Surgery Augmentation Surgery Desire to “fit in” and be “normal” Desire to feel womanly and Balance difference in breast size attractive May not be told about hypoplasia and Doubts about femininity possible diminished lactation capability Low self-esteem Copyright © 2014 by Diana West, IBCLC 3 Breastfeeding After Cosmetic Breast Surgery Presented by Diana West, BA, IBCLC Psychological Reasons for Psychological Augmentation Surgery Reasons Study by Didie and Sarwer (2003) “Most women who seek Reasons women have breast breast augmentation are augmentation surgery not trying to outdo other women in breast size; More motivated by their feelings rather they want than partners or socio-cultural to catch up.” representations of beauty Higher incidence of: Surgery of the Breast: Principles and Art . Divorce (Spear, ed) . Unhappy marriages . Emotional discomfort . Diminished feelings of femininity . Depression Lactation Implications of Nerve Impairment Augmentation Surgery Plastic surgeons often tell mothers that augmentation will not affect breastfeeding “since nothing is being removed from the breast” This overlooks many factors of augmentation surgery that can affect lactation Nerve Impairment Regeneration of damaged nerves Body’s normal repair process Responds to passage of time Regrow at rate of 1 mm/month Copyright © 2014 by Diana West, IBCLC 4 Breastfeeding After Cosmetic Breast Surgery Presented by Diana West, BA, IBCLC Why Does Nerve Duct Impairment Response Matter? Milk ejection reflex Recanalization depends on nerve response = Growth of ductal tissue Good News: Milk .Severed ducts reconnecting? ejection can be triggered without .New ductal pathways? direct nerve response Breast compression . If implant above the muscle, should be done with hand on top Duct Impairment Duct Impairment Responds to hormonal Lactation outcome and physical stimuli also depends on . Tissue grows and matures with each inherent number of menstruation and pregnancy glands and ducts . Direct response to lactation (Daly, Kent, Owens, Hartmann, 1999) Recent discovery: • Number and length of lactations after surgery Number of ductal openings on nipple vary (Ramsey, 2005) • Better outcomes for subsequent lactations Can vary from 4-15 Average of 9 Two Main Augmentation Technique Categories Augmentation by Injection Injection Implantation Copyright © 2014 by Diana West, IBCLC 5 Breastfeeding After Cosmetic Breast Surgery Presented by Diana West, BA, IBCLC Lipoaugmentation Lipoaugmentation Patient’s Own Body Fat Injected into Breasts Patient’s Own Body Fat Injected into Breasts Harvested from liposuction One technique uses Brava® Can fill in defects / abnormalities or soften existing external breast tissue implant appearance expander No clinical evidence safer or better than saline / silicone . increases breast Enlargement depends on amount of spare fat vascularity / volume . prevents fat reabsorption Lipoaugmentation Hyaluronic Acid (HA) Injection RISKS Soft gel-like substance injected into breasts LIMITED to ~1 cup size increase Hyaluronic acid occurs naturally in the body Procedure may have to be repeated Marketed under name “Macrolane” Unpredictable or low survival rates of transferred cells Known by doctors as a "Boob Jab” Cell reabsorption Out-patient “lunchtime” procedure Cyst development Local anesthesia Tissue scarring Placed under breast tissue Calcification Procedure less than 1-2 hours Difficulty detecting breast cancer by mammogram Almost no recovery time . Differentiating between malignant and fat transfer calcifications Allen RJ, Heitland AS. Autogenous augmentation mammaplasty with microsurgical tissue transfer. Plast Reconstr Surg. 2003 Jul;112(1):91-100. Hyaluronic Acid (HA) Injection Requires yearly touch-ups Used primarily in Europe (not UK) Prior to 2012 British Association of Aesthetic Plastic Augmentation Surgeons, (BAAPS) saw one in four complications by Implantation In 2012, Swedish manufacturer Q-Med withdrew Macrolane from UK market due to “cancer screening concerns” Not yet approved by FDA or Health Canada EFFECT ON MILK AND BREASTFEEDING UNKNOWN Copyright © 2014 by Diana West, IBCLC 6 Breastfeeding After Cosmetic Breast Surgery Presented by Diana West, BA, IBCLC Types of Implants Types of Implants Saline Silicone FDA approved for age 22 FDA approved for age 18 Small incision Pre-filled so need Saline filling can be larger incision increased or decreased Usually inframammary incision Can’t use axillary incision Implant Outcome Variables Implant Location Two primary factors affect the Subglandular amount of milk the mother will be UNDER the able to make gland ABOVE the 1. Implant location muscle Subpectoral 2. Incision placement UNDER the muscle Implant Location Implant Location Subglandular (ABOVE the muscle) Subpectoral PRO (BELOW the muscle) . Least complicated PRO . Chest muscles cannot . capsular contracture move implant when flexed . visible implant rippling CON CON . risk capsular contracture . implant vulnerability . Recovery time longer . risk implant "rippling” . More painful . pressure on glandular tissue . more likely to negatively affect milk production Copyright © 2014 by Diana West, IBCLC 7 Breastfeeding After Cosmetic Breast Surgery Presented by Diana West, BA, IBCLC Implant Location Incision Placement For aesthetics, surgeons place incisions in less visible areas Four most common incision sites: Inframammary Tunneling to implant location from Transaxillary remote incision can cause duct Transumbilical and nerve damage Periareolar Same Scars Patterns Selected Breast Augmentation Techniques and their “Surgery of the Breast: Principles and Art,” Spear, ed., 1998. Probable Effects Augmentation with lift on Lactation (mastopexy) can look the same as reduction “Surgery of the Breast: Principles and Art,” Spear, ed., 1998. Periareolar Greatest risk to lactation is periareolar incision (Hurst, 1996) Very common Likelihood of severed ducts Incision around areola to hide Likelihood of severed nerves scaring . Incisions in the lower, outer quadrant will result in Can be placed reduced innervation to the nipple and areola subglandular or . Dramatically reduces milk ejection response subpectoral LIKELY to damage ducts, glands, and nerves “Surgery of the Breast: Principles and Art,” Spear, ed., 1998. Copyright © 2014 by Diana West,
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