Concerns with over the Muscle Breast Implants After Pregnancy

I am about to get married and we wanted to start a family right away. My whole family has breast fed and I plan on doing the same. Also, I know that typically after pregnancy you tend to lose volume in your breasts. What are the odds with over the muscle placement for breast implants? Will be able to breast feed, and is it safe for the baby? Am I more likely to retain the volume in my breasts due to the implant being on top of the muscle?

Doctor Answers 4

Breast Implants and Breast Feeding Information

It doesn't make any difference if your implants are above or below your muscle with regards to breast feeding. The incision site may make a difference  
The incision site, specifically the periareolar incision may cause blocked milk ducts and decrease your ability to breast feed though in my experience most will still be able. Remember not all women can breast feed successfully. Fat transfer for breast augmentation has not been around long enough for scientific studies so the answer is not in yet. It is a safe procedure but in my experience you are only talking about half a cup size per procedure. Our current state of knowledge is that Silicone Implants are Safe for Breast Feeding  Silicone Implants Are Safe Despite three decades of safety testing and monitoring of silicone breast implants, there is still a public perception that silicone breast implants are more toxic or dangerous than saline implants. The truth is that there has no known toxicity from silicone gel breast implants. In fact, silicone is one of the most common materials used in medical devices and implants. There is no known toxicity from silicone gel breast implants. It has been studied by the FDA for more than three decades to establish its safety. Silicone is the most common material used in medical devices/implants. Examples include shunts that go from the brain to the abdomen (for hydrocephalus) which are left in for a lifetime, artificial finger joints, syringes, IVs, catheters (including ones that go next to the heart), surrounding pacemakers, and even oral anti-gas tablets.
The one possible exception may by the PIP implant made in France (generally not available in the USA). Most of the concerns about the PIP implant were about the use of non-medical silicone and manufacturing problems, and do not relate to implants used in the United States by board-certified plastic surgeons. This is not to say that breast implants, like any implant, can have problems; they may have to be removed and are not meant to last a life time. Common reasons for replacement include: capsular contracture, rupture, infection, change in breast size, and pain—but not for toxicity.
To answer the perceived toxicity of Silicone by the general public—this is quite a different matter.
Breast implants have been around since the 1960s. About 15 years ago Connie Chung ran an exposé, Face to Face with Connie Chung, claiming silicone implants were responsible for different health problems. This led to lawsuits, a huge windfall for lawyers, and the subsequent ban on silicone implants for first-time breast augmentation patients went into effect. They were always available for breast reconstruction (e.g. after mastectomy) and replacement of existing silicone breasts. Also, please note that saline implants are still covered by a silicone envelope.
Soon after, a ban on silicone implant use became worldwide. This lasted for years until more than 100 clinical studies showed that breast implants aren’t related to cancer, lupus, scleroderma, other connective tissue diseases, or the host of other problems they were accused of causing.
June 1999, The Institute of Medicine released a 400-page report prepared by an independent committee of 13 scientists. They concluded that although silicone breast implants may be responsible for localized problems such as hardening or scarring of breast tissue, implants do not cause any major diseases such as depression, chronic fatigue syndrome, lupus or rheumatoid arthritis, etc.
The Institute of Medicine is part of the National Academy of Sciences, the nation’s most prestigious scientific organization.
Eventually, a federal judge dismissed/rejected the lawsuits, declaring them junk science and ended for the most part the barrage of lawsuits. This led to the present reintroduction of silicone implants years ago and their approval by the FDA. Interestingly enough, most of the rest of the world reintroduced them many years prior to the United States

Orange County Plastic Surgeon
5.0 out of 5 stars 90 reviews

Go under the muscle

There is really no good reason to be above the muscle in my opinion. The mammograms are less accurate, the implants look more edgy and are more palpable, the capsular contracture rates are higher and they don't look as natural.

These issues plus the fact that above the muscle implants DON'T LIFT YOU make this position useless in my practice.

Under the muscle is your best option

The less that is done between the breast tissue and the nipple the better the chance of successful breast-feeding. I tell all of my patients that I cannot guarantee that they will be able to breast feed with or without surgery. Under the muscle isolates more of the implant from your breast tissue, at least in the upper half to 2/3 of the breast. Additionally some literature suggests that incisions aroud the areola may decrease your ability to breast feed. This is a great question as well to discuss at your initial consultation with your borad-certified plastic surgeon. Best of luck to you.

Dr Edwards

If you are concerned about breast feeding then under the muscle implants are a better option.

When implants are placed under the muscle through an incision underneath the breast (in the crease), there is no division of the breast tissue or breast ducts (well, very little). However, when implants are placed directly under the breast over the muscle, there is a greater liklihood that milk ducts will be divided (especially if the incision is around your areola/nipple), and you will have decreased milk production. I would recommend submuscular implants for you if you are concerned about breast feeding in the future. As far as safety to the baby, studies show there is no greater risk with implants. Also, to answer your question, your are not more likely to retain volume in your breasts due to the placement of an implant prior to pregnancy. Hope this was helpful!

David Rankin, MD
Jupiter Plastic Surgeon
5.0 out of 5 stars 91 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.