Breastfeeding with OTM Implants - what is the success rate?

Question

I read in a paper that the success rate for breastfeeding with submuscular implant placement is 83% and with subglandular placement is 17%. During consultation, one of the surgeons mentioned these numbers are outdated and what matters more is surgical technique that avoids damage to the milk ducts and nerves. Are there more updated numbers on what the % success is with UTM and OTM placement? I read that since the implant with OTM placement compresses the milk ducts and can impair milk flow. I would imagine that it would still affect it in some way. With OTM placement, would I be at higher risk of developing mastitis if the inplant compresses the ducts? And would that put me at higher risk if capsular contracture since the implant is at close proximity of the infected ducts? What can I do to avoid this?

Emre Guvercin, MD, FEBOPRAS · Answer

The older 83% vs 17% breastfeeding numbers are outdated and oversimplified. Current evidence and clinical experience show that both under-the-muscle (UTM) and over-the-muscle (OTM) implants can allow successful breastfeeding. What matters more than the implant plane is surgical technique&mdash;specifically preserving milk ducts, nerves, and blood supply, and choosing incisions that avoid ductal injury.OTM implants can theoretically increase pressure on the ducts in some patients, especially with large implants or tight pockets, but this does not mean breastfeeding will fail, and many women breastfeed successfully with OTM placement. Mastitis can occur with or without implants; if it happens, early treatment is important. While inflammation may theoretically contribute to capsular contracture, this is uncommon in practice.Regarding timing, the safest approach is to have surgery before pregnancy or at least 6 months after breastfeeding has completely ended, allowing breast tissue and hormonal changes to fully stabilize.Bottom line: Both UTM and OTM are generally safe for future breastfeeding when performed with proper technique, and correct timing further reduces risks.

Ted Eisenberg, DO, FACOS, FAACS · Answer

In my experience with over 7500 women that had breast augmentation with me (or over 15,000 breasts) only 6 breasts had capsular contracture. All surgeries were performed part under the muscle and part under the breast gland (dual plane). Not all women are naturally able to breast feed, but those that can theoretically should still be able to when placed behind the muscle. This has been my experience. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Donovan Rosas, MD · Answer

The presence of implants should not influence your decision to breast feed. You should be able to safely breast feed regardless of prior surgery and should consider doing so for the sake of the newborn. There is mountains of data regarding the immunologic benefits of breastfeeding. 
Interruption of the structures glandular/ductal structures is very technique dependent but should be preserved regardless of approach. Typically, there is no reason to disrupt gland/duct connections in implant placement. That being said, the likelihood of inadvertent damage is logically higher for a subglandular/subfascial approach.
With regards to your specific question, subglandular/OTM placement does demonstrate higher rates of capsular contracture regardless of breastfeeding status. There is some encouraging data on subfascial placement, however, long term data is limited.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

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