January 20, 2020
Breast Surgery, Piercing, and Radiation
Women with a history of excisional biopsy rarely have problems breastfeeding.
A history of nipple piercing rarely impacts breastfeeding. Very occasionally there may be some leakage from the piercing sites, and possibly scarring which would impact lactation1. The jewelry pieces should be removed during lactation.
Breast augmentation usually does not impact breastfeeding, since implants are typically placed behind the pectoralis muscle, not within the breast tissue2. Occasionally implants can cause discomfort due to breast fullness or engorgement. A history of breast augmentation may be a marker for insufficient glandular tissue, because these women may have had small, atypical appearing breasts, hence the reason for implants3. If the mother has a history of one or both breasts appearing significantly underdeveloped before surgery, she is at greatly increased risk of low milk supply. Always ask a mother why she had the augmentation surgery, and what her breasts looked like before surgery.
Breast reduction surgery is much more likely to have a negative impact on milk supply because it generally involves removal of a large amount of breast tissue4. These moms can usually breastfeed, but they have a high risk of not establishing sufficient milk production to meet infant needs. Infants need to be closely monitored for milk intake and weight gain, and for this reason, nursing mothers with a history of breast reduction should receive care and guidance by a lactation specialist prenatally if possible. Supplementation at breast at the first sign of infant need can help maintain the breastfeeding relationship and optimize production. A good online resource for breastfeeding mothers with a history of breast reduction is www.bfar.org.
Women with a history of radiation to one breast for cancer are not expected to produce any milk from the irradiated breast. Women who undergo radiation for other conditions such as Hodgkin’s disease have much less radiation exposure to their breasts. These women should be watched carefully for adequate milk production, but are at lower risk for insufficient lactation.
- Garbin CP, et al. Association of Nipple Piercing With Abnormal Milk Production and Breastfeeding. JAMA. 2009;301(24):2550–2551. doi:https://doi.org/10.1001/jama.2009.877
- Jewell ML, Edwards MC et al Lactation Outcomes in More than 3500 Women Following Primary Augmentation: 5-Year Data from the Breast Implant Follow Up Study Aesthetic Surgery J 2018 1-9
- Marasco, LA Unsolved Mysteries of the Human Mammary Gland: Defining and Redefining the Critical Questions from the Lactation Consultant’s Perspective J Mammary Gland Biol Neoplasia (2014) 19:271-288
- Kraut RY, Brown E, Korownyk C, et al. The impact of breast reduction surgery on breastfeeding: Systematic review of observational studies. PLoS One. 2017;12(10):e0186591. Published 2017 Oct 19. doi:10.1371/journal.pone.0186591