What Breast Feeding Complications are Associated W/ Fat Transfer Breast Augmentation?

Question

I am debating between "natural" breast augmentation using fat grafts and traditional breast augmentation using saline implants placed below the muscle and inserted either thru the areola or the axilla. I want to know if there is any evidence suggesting fat transfer to the breasts may adversely affect a woman's ability to breastfeed, and if so, whether this risk is GENERALLY greater than that associated with the aforementioned "traditional" approach to augmentation using implants.

Elizabeth Slass Lee, MD · Answer

Breast augmentation with implants does not interrupt connections between breast glands and the ducts leading to the nipple, and so does not affect the ability to nurse.  Fat grafting to the breast is a new, hot procedure but is not yet well studies regarding long term safety, durability and outcome.  No study has looked at breast feeding after fat graft augmentation, but unlike implant insertion in which all work is done deep to the breast, fat grafting involves many large needle sticks into the breast tissue, and logically has the potention to injure the breast gland and ducts, affecting breast feeding.  More importantly though is that changes caused by fat grafting may make detection of cancer much more difficult with screening mammography.  Implants are not a perfect solution, but they are proven and safe.  The jury is still out on the safety of fat grafting to the breast for augmentation.

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

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. Silicone implants are also safe and have the advantage of being predictable and allowing you the size you want. It should not interfere with breast feeding. Silicone Implants Are SafeDespite 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

Richard H. Tholen, MD, FACS · Answer

Neither implants (silicone or saline) nor fat transfer should have any effect on ability to breast feed, or cause any change in the quality or safety of the breast milk. This has been looked into exhaustively (as related to silicone breast implants--1999 study by US Dept of Health and Human Services, Institute of Medicine, National Academy of Sciences) and the conclusion was that "evidence for health effects in children related to maternal breast implants is insufficient or flawed."

	Fat grafted breast tissue, however, while not causing concern related to breast feeding, DOES raise concerns with mammographic detection of breast cancer. Specifically, some of the grafted fat does not survive, and can cause the development of calcifications that could mimic calcifications associated with breast cancer, potentially interfering with cancer detection. Grafted fat that does not survive can also cause scar densities that further interfere with mammography. Though these may be described as "potential" or "theoretical" concerns, breast implants (particularly submuscular ones) do not cause these concerns (though some would argue that periareolar incisional approaches with dissection through the breast tissue could also cause these confusing scar densities or calcifications much the same as fat grafts.)

	'There is a reason that "traditional" breast augmentation is recommended by the vast majority of experienced, ABPS-certified plastic surgeons (and fat grafting is NOT), and that is because implants still represent the best and safest way for a woman to enlarge her breasts.

Peter E. Johnson, MD · Answer

There are no available studies or information on breast feeding after fat transfers to augment the breast. There are plenty on breast implants and they will have no effect on breast feeding. Fat transfers to the breast are controversial because of liquid cysts and calcifications produced and the literature is not trending in a 'positive' way. Be careful.

	Best of luck,

	peterejohnsonmd

Marcus L. Peterson, MD · Answer

The impact of fat transfer on breast feeding is not known.  If you are doing a breast augmentation with fat transfer you will probably need multiple sessions and still not get to the size that an implant can give you. After multiple sessions of fat transfer and some expected fat absorption there is no study to determine what the impact on breast feeding will be.  We do know that there is very little impact on breast feeding when an implant is placed below the muscle.

	Best Wishes

	Dr. Peterson

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