Breast implants - Should I have waited until I was done breastfeeding?

Breast augmentation is a wonderful operation, but patients must realize that every operation has its limitations. Patients should be aware that they will most likely require more than one, and possibly several, operations over their lifetime in order to maintain the appearance of their breasts.

A breast augmentation that gives a woman a beautiful outcome at age 25 cannot be expected to look the same at age 35 or 45, for a variety of reasons. Pregnancy, breast feeding, and the usual slow but gradual weight gain as we age will all conspire to undo the previously beautiful appearance of the breast when you were 10 years younger and/or 15 pounds lighter, and before breastfeeding your children.

Even in the absence of pregnancy and breast feeding, the effect of gravity and natural atrophy of your breasts as a function of age and time will take their toll and make the breast appear somewhat saggy. Add to that the possibility of capsular contracture around the breast implant or age-related deterioration of the implant (silicone or saline), and it is almost expected that the breasts will need a revision in order to restore them to an attractive appearance.

With many cases of revision breast implant surgery, and even in some cases of primary breast augmentation, a breast lift or "mastopexy" is also required in order to restore the proper proportion of skin envelope to breast volume that makes the breast look attractive.

Although more scars are necessary for this procedure than for augmentation alone, the scars are a worthwhile trade-off to achieve a well-proportioned breast, rather than placing a larger breast implant to take up the slack in the skin.

Even younger women who have not had pregnancies or breast fed sometimes require the mastopexy lift, and waiting until they have had their children and finished breast feeding will not change the requirement for the lift if the intention is to make the most attractive breast possible.

The mastopexy lift can also be "re-lifted" if needed, after age and child-bearing have changed the appearance of the breast.

The implants are not lifetime devices, and it should be expected that they need replacement after 10+ years of service.

Your breasts will age in tandem with other changes taking place with your body, and change is inevitable. It is expected that you will need to do some maintenance and upkeep in order to keep your breasts looking good after they have done their work!

In general, you want to be done having children before having breast implants if you are in the midst of starting your family.  This is only so you have less chance of needing a revision if your breasts change after having another child.  There is no health risk to having the implants and then getting pregnant, though.

The implants don't promote or prevent sagging of the breasts, so you probably would be in the same situation either way right now.  Just make sure the surgeon you go to has shown you many photos of lift patients because this is much more of a sculpting art form than just placing breast implants.  If you can get a great shape, most patients will not mind the scars needed to get there.

When looking at the question of implants before or after children the questions that need to be taken into consideration are: starting cup size, how big did you get during pregnancy, how many children did you have, did you breast feed, do you have stretch marks, and are you smaller now that before your pregancy?

Typically a woman will have what is known as post-partum involution after the stimulus for milk production is gone. This means that breasts shrink. Some shrink so much, that with stretch marks, they look like a deflated balloon. If this results in your nipples sitting at the level of your breast fold or below, visually, then a breast lift with all the attendant scars is a necessity.

Because you had implants, you lost even more of your native breast tissue over time from atrophy creating that deflated look that got exaggerated by the weight of your implants. If you have stretch marks on your breast, the skin is fairly inelastic and can't really hold the extra weight of the implant causing it to sag to the point it needs a lift

I know that you don't really want the scars, but in all honesty they actually heal quite nicely. You can even use IPL laser to help fade the redness faster.

I hope this helps.
Dr. Shah

That is hard to predict.  The quality of each patient's tissues varies tremendously.  As one ages the skin elasticity changes.  Also, pregnancy alters the skin quality by stretching it out when engorged.

 Pregancy and breast feeding can change the shape and size of your breasts, and having implants before pregancy can certainly lead to revisions.  That being said, going 18 years without the need for a revision is quite a good result!! 

Patients need to understand that breast implants are not a lifetime devices.  Having breast implants guarantees you at least one additonal surgery somewhere in your lifetime.  The risk of a spontaneous rupture of a breast implant is very, very low, but after about 11 or 12 years, it begins to slowly trend upward. 

• Current recommendations by the American Society of Plastic Surgeons is a replacement surgery every 10 years.

Breast implants can speed the inevitable drooping of your breasts with age- the larger the implant, the heavier it is, and the faster drooping will occur.  After having 4 children and breast feeding, I would be very suprised if you would not have developed some drooping whether you had gotten implants or not.