At a glance
Some breast surgeries affect milk production more than others. Those who have had breast surgery may need additional support to breastfeed.
Safety of silicone breast implants
Research is limited; however, there are no recent reports of clinical problems in infants of mothers with silicone breast implants. A 2001 statement from the American Academy of Pediatrics indicated insufficient evidence to classify silicone implants as a reason to not breastfeed.
Breast or nipple surgery
Most mothers who have had breast or nipple surgery can produce some milk, but they may not produce a full milk supply. Women without a full milk supply can still breastfeed. However, they may need to supplement their breast milk with infant formula or pasteurized human donor milk.
Breast augmentation, lift, and reduction
Breast augmentation, lift, and reduction procedures may affect the nerves and ducts within the breast and thus affect lactation. Breast implants below the muscle usually affect milk production less than implants above the muscle.
Incisions around the areola and surgery that completely detaches the areolae and nipples are more likely to cause reductions in milk production. Over time, ducts severed during surgery may grow back together or form new pathways. Nerves may regain functionality, enabling the mother to produce milk.
A scar around the whole areola following breast reduction does not indicate complete detachment. The areola may have remained connected to tissue containing nerves, ducts, and blood supply.
The amount of milk made will depend on the number of connected ducts and function of nerves that enable lactation. Factors apart from the surgery, such as hormones and milk removal, may also affect milk production.
Babies of mothers who have had breast surgery should be carefully monitored for adequate weight gain. Mothers may need support to increase milk production and/or to supplement with pasteurized donor human milk or formula.
Mastectomy
Women who have been treated for breast cancer with partial or total mastectomy may have reduced capability to breastfeed or produce breast milk. Partial or total mastectomy can result in the removal of breast tissue and damage to essential nerves involved in lactation.
Women with total mastectomy of one breast can breastfeed from the unaffected breast. Women with partial mastectomy and radiation therapy should expect significantly reduced milk production on the affected side(s). A single breast can produce enough breast milk for healthy infant growth. However, the infant's weight should be followed closely. See further guidance in the Academy of Breastfeeding Medicine's clinical protocol.
Women may have varied experiences with breastfeeding after breast cancer treatment. They may also experience a range of social and psychological challenges. Providers may need to address psychosocial challenges when supporting the infant feeding decisions of women who have had breast cancer.
Hypoplastic breasts
Some mothers may have had underdeveloped (hypoplastic) breasts prior to having breast surgery. Mammary hypoplasia, or insufficient glandular tissue, is characterized by breasts that appear tubular, widely spaced, or significantly asymmetrical. Some women with this condition seek reconstructive surgery. Mothers who have had hypoplastic breasts may not be able to produce enough milk for their infants. They will need lactation support to learn how to stimulate production and/or how to supplement with pasteurized donor human milk or formula.
Helping mothers who have had breast surgery
Prenatal support (before childbirth)
Talk with mothers about the type of surgery, placement of incisions, and underlying reasons for the surgery to understand the potential for reduced milk production.
Examine mothers' breasts to identify possible insufficient glandular tissue and provide anticipatory guidance for breastfeeding support.
Postpartum support (after childbirth)
Closely monitor infants to be sure they receive optimal nutrition for growth.
When mothers have insufficient milk production, inquire about prior breast surgery as part of your assessment.
Refer to an International Board Certified Lactation Consultant (IBCLC) to teach mothers who have had breast surgery how to stimulate production and/or how to supplement with pasteurized donor human milk or formula.
Ensure that mothers who have had breast surgery and encounter breastfeeding challenges receive appropriate emotional support.
- Walker M. Breastfeeding Management for the Clinician: Using the Evidence. 4th ed. Jones & Bartlett Learning; 2016.
- Lawrence RA, Lawrence R. Breastfeeding: A Guide for the Medical Profession. 8th ed. Elsevier; 2015.
- Johnson HM, Mitchell KB; Academy of Breastfeeding Medicine. ABM Clinical Protocol #34: Breast Cancer and Breastfeeding. Breastfeed Med. 2020 Jul;15(7):429-434.