Some women have breast surgery or other breast-altering interventions because of health issues or for aesthetic reasons. These include breast enlargement or reduction operations and nipple piercings. If you have undergone a procedure of this kind, it is advisable to contact a breastfeeding specialist during pregnancy and to inform the attending physicians or midwife.
If you have had breast surgery or piercing, it is still fundamentally possible to breastfeed. For the breast to produce milk, the nipple must be connected to the mammary gland. In addition, the nipple must be sensitive so that production of the hormones which are ultimately responsible for milk production and flow is triggered.
In the case of cosmetic breast enlargement surgery the implant is usually inserted either through an incision in the inframammary fold (the crease underneath the breast) or an incision made around the outer edge of the areola. Although the latter method results in a less visible post-operative incision, it may result in damage to the milk ducts and important nerves. If the incision is made in the inframammary fold, the ability to breastfeed is usually unaffected. It remains uncertain whether leakage of the substances used to fill implants (usually silicon) into the mother's body can pose a risk for the child; there still isn’t enough data on this subject to answer the question reliably. In addition, there are currently no good analytical methods for measuring whether and how much silicon has been absorbed by the mother’s milk.
Large breasts can cause pain in the back, shoulders or neck. Although breast reduction surgery involves the removal of breast tissue, most milk ducts, blood vessels and nerves are preserved. However, mammary gland tissue is also sometimes removed, and this can affect milk production. The more time that has passed since the surgery, the greater the chance that the nerves and milk ducts will have regenerated. This depends, however, on how much breast tissue was removed and whether the nipple was removed and placed higher up on the breast. Breastfeeding may be severely restricted in this case. Following breast reduction surgery there can sometimes be a delay in the onset of milk production, but the quantity of milk will increase over time. Expressing milk in addition to breastfeeding can help stimulate production.
A well-healed nipple piercing is not generally an obstacle to breastfeeding. However, scarring is sometimes present and milk may be discharged from the piercing. Jewellery must always be removed before breastfeeding as it can irritate the baby and may injure its mouth. In the worst case scenario, the jewellery may even be swallowed. Women who opt to remove their nipple jewellery completely during the breastfeeding period and intend to wear it again once the child has been weaned should use an expander to ensure that the piercing does not heal over.
Experts advise against nipple piercing during pregnancy since it can lead to the onset of contractions. Ideally the piercing should be made at least 12 to 18 months before a planned pregnancy so that the wound has time to heal properly.
As a rule, breast surgery should not be considered until you have decided not to have any more children. Where breast enlargement surgery is concerned, implants may no longer fit correctly after pregnancy and larger or smaller implants may be required. In other words, you might have to have another operation after the pregnancy.