Concerns with over the Muscle Breast Implants After Pregnancy

Question

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?

Larry S. Nichter, MD, MS, FACS · Answer

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

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question!  Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts.  Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years.  In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance.  Your breast width is the most important measurement.  Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant.  This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape.  Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width.  Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later. Very slightly less tissue may be visualized with subglandular implants, but not very significant.Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle).  Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each.  In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome.  A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles.  Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions.  As you see, there are a few factors to decide upon for incision, placement, and implant type/size.    Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits.  Hope that this helps! Best wishes for a wonderful result!

David Rankin, MD · Answer

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!

Michael C. Edwards, MD, FACS · Answer

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

Richard P. Rand, MD, FACS (retired) · Answer

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.

Concerns with over the Muscle Breast Implants After Pregnancy

Answers (5)