Breast Implant Controversy - Implants and Breast-feeding

Implants and Breast-feeding

The functional breast

The breasts are apocrine glands that produce milk for the feeding of infant children; each breast has a nipple within an areola (nipple-areola complex, NAC), the skin color of which varies from pink to dark brown, and has sebaceous glands. Within the mammary gland, the lactiferous ducts produce breast milk, and are distributed throughout the breast, with two-thirds of the tissue within 30-mm of the base of the nipple. In each breast, 4–18 lactiferous ducts drain to the nipple; the glands-to-fat ratio is 2:1 in lactating women, and to 1:1 in non-lactating women; besides milk glands, the breast is composed of connective tissue (collagen, elastin), adipose tissue (white fat), and the suspensory Cooper's ligaments. The peripheral nervous system innervation of the breast is by the anterior and lateral cutaneous branches of the fourth-, fifth-, and sixth intercostal nerves, while the Thoracic spinal nerve 4 (T4) innervating the dermatomic area supplies sensation to the nipple-areola complex.

Digestive contamination and systemic toxicity are the principal infant-health concerns; the leakage of breast implant filler to the breast milk, and if the filler is dangerous to the nursing infant. Breast implant device fillers are biologically inert — saline filler is salt water, and silicone filler is indigestible — because each substance is chemically inert, and environmentally common. Moreover, proponent physicians have said there “should be no absolute contraindication to breast-feeding by women with silicone breast implants.” In the early 1990s, at the beginning of the silicone breast-implant sickness occurrences, small-scale, non-random studies (i.e. “patients came with complaints, which might have many sources”, not “doctors performed random tests”) indicated possible breast-feeding complications from silicone implants; yet no study reported device–disease causality.

The augmented breast

Women with breast implants are able to breast-feed; however implant devices may cause functional breast-feeding difficulties, especially the mammoplasty procedures that feature periareolar incisions and subglandular emplacement, which have greater incidences of breast-feeding difficulties. Surgery may also damage the lactiferous ducts and the nerves of the nipple-areola complex (NAC).

Functional breast-feeding difficulties arise if the surgeon cut the milk ducts or the major nerves innervating the breast, or if the milk glands were otherwise damaged. Milk duct and nerve damage are more common to the periareolar incision implantation procedure, which cuts tissue near the nipple, whereas other implantation incision-plans — IMF (Inframammary Fold), TABA (Trans-Axillary Breast Augmentation), TUBA (Trans-Umbilical Breast Augmentation) — avoid the tissue of the nipple-areola complex; if the woman is concerned about possible breast-feeding difficulties, the periareolar incisions can be effected to reduce damage to the milk ducts and to the nerves of the NAC. The milk glands are affected most by subglandular implants (under the gland), and by large-sized breast implants, which pinch the lactiferous ducts and impede milk flow. Small-sized breast implants, and submuscular implantation, cause fewer breast-function problems; however, women have successfully breast-fed after undergoing periareolar incisions and subglandular emplacement.