Breastfeeding Using Implant Breasts

Breastfeeding Function

Breasts are basically a milk-producing glands which are used to feed babies. There is a nipple in an aerola area (or called nipple areola complex—NAC), with varying colors from pink to dark brown. Within this gland, breast milk is produced by lactiferous ducts and distributed throughout the breast. For every breast, there are four until eighteen lactiferous ducts ending to the nipple. The comparison of glands to fat within the breasts tissue is 2 to 1—in lactating women—or 1 to 1—in non-lactating women. Thre are more than just glands inside a woman’s breasts; there are collagen, elastin, fat, and ligaments. There are also nerve system in breasts, where the anterior and lateral branches of the fourth, fifth, and sixth nerves are located. Thoraric spinal nerve 4 or T4 in breasts also supplies a specific sensation to the nipple area.

The most important concerns about breastfeeding is in the potential of digestive contamination and toxicity. If the filler of breast implant device is leaked to the breast milk, it will endanger the baby. Substances contained in a breast implant filler is chemically and biologically inert, because they were made of environmentally common substances like salt water (for the saline filler)—although silicone in the filler is unable to be digested. Besides, experts have said that whatever the reasons, there shouldnot be any contraindication for breastfeeding by women with implanted breasts. In the beginning of the use of breast implant (at early 1990s), perhaps there are many non-technical complains from patients and doctors about possible complications from the implant device. Yet, there is no disease casuality related to the device.

Augmented Breasts

Meanwhile, women with implanted breasts are still able to feed babies using their breasts. But, this implant devices may give a kind of difficulties. Mammoplasty surgery, which includes a periareolar incisions and subglandular replacement, is the main cause of this difficulties. Moreover, other difficulties are about the potential damage of lactiferous ducts and the nerves around the nipple area.

If the surgeon cut the ducts and any major nerves within the breast tissue or if the glands are damaged somehow, possible difficulties risk arises. The first is common to surgical procedures that involve periareolar incision implantation because it cuts breast tissue close to the nipple. In the other hand, other implantation incisions like inframmamory fold, trans-axillary breast augmentation, or trans-umbilical breast augmentation, avoid this step. However, if the patient is serious about the possibilities of this breastfeeding difficulties, she can ask the doctor to make effective the incision step so that the damage of the milk ducts and nerves can be reduced. Basically, only implants that are placed under the gland (or called subglandular implants) and implants for large-sized breast that mostly affect the milk glands. Implantation for small size breasts and for submuscle gives less risk of breastfeeding function problems.

Surgical Procedures of Mastopexy

Mastopexy for Women

Before performing a mastopexy, surgeons will see if the woman who wants to do this breast-lift surgery comprehends the medical benefits and risks of the procedure. She needs to understand that there are certain body images that can be and cannot be achieved from mastopexy. Some of the indications before running a mastopexy are sagging breasts, post-explantation ptosis, congenital ptosis and pseudoptosis, and acquired or relative ptosis,

For the sagging breast

Mastopexy of the sagging breasts are inquired for both full breast- and modified breast-lift. This technique can only be performed to the surgical incisions to the skin envelope of the breast, not the parenchyma (or the inner substance of the breast).

For a full breast lift, the sagging breasts are lifted under circumvertical and horizontal incision from the Anchor mastopexy. This includes three kinds of incisions: (1) the Anchor ring, an circle-shaped incision on the upper part of the nipple-areola complex; (2) the Anchor shank, a vertical incision from the lower part of the nipple area until the inframammary incision; (3) the Anchor stock, a horizontal incision around the inframammary or around the joint between breast and chest.

In cutting the folds of excess skin from the sagging, inelastic skin-envelope of the breast (and occasionally reducing the nipple-areola complex diameter), the three-incision technique of the Anchor mastopexy allows maximal corrections to the breasts, thereby producing an elevated bust with breasts of natural size, look, and feel. Moreover, each of the three scars to the breast hemisphere produced by the Anchor-pattern mastopexy has a characteristic healing pattern:

To cut the excess skin created from this process (which acquires the sagging skin envelope of the breast, sometimes includes the nipple area diameter), these three kinds of incision permit some maximum corrections of the breasts. Then, it produces an elevated breasts with natural size and appearance. And removing the scars on the breasts due to the mastopexy process requires a skin pigment transition from light to dark skin color—light skin for the breast and dark skin for the areola skin. This is performed for scars around the periareolar area. Meanwhile, for scars on the medial vertical around the nipple areola complex to the inframammary fold or horizontal scars around it, there is no concealing needed because the scars are hidden by the shadow of the breast.

Post-surgically, of the three breast-lift surgery scars, the scar to the inframammary fold exhibits the greatest tendency to hypertrophy, to thickness and large size. Although the coloration of mastopexy scars fades with the full maturation of the tissues, they do remain visible.

In mastopexy for modified breast lift, it takes smaller number of cuts and scars. However, it does not allow the surgeon to make more changes to the skin envelope of the breast. In most occurences, modified breast lift is regarded as a sub-ordinate surgery under a mastopexy for breast augmentation surgery. Sometimes it is also included after lifting and enlarging breast surgery. Some variations of incisions in the modified breast lift are:

• periareolar lift, with a crescent shaped incision above and at some part of the nipple area, will cut and remove the crescent flesh so that the transposition of the nipple will be a bit higher compared to the breast;
• circumareolar lift, with a cut on the concentric ring flesh around the nipple area, will prohibit the size of the circle-shaped scar to be maximum;
• circumvertical lift, with a circumareolar incision around the circle of nipple area and a vertical incision starting from the lower part of the nipple until the inframammary fold.

For the augmented breast

Breast augmentation is sometimes followed by a high potential of breast ptosis. Breast ptosis may be created by stresses—both mechanically and physically—from the implanted breast to the tissue and skin envelope. The overstrecthing thins of the skins may result in the stresses. But, however, based on statistic, breast augmentation and mastopexy come with low medical risks, although the risks may increase of the two are performed altogether and as a combination. The risks can increase the potential of infection of the incision, exposure to the implanted breast, breast and nipple nerves damage, and deformity of nipple and breast implant. The reason of this risk is that breast augmentation and mastopexy, when performed as a combination, may increase the surgical complication level—at least compared to if each is performed separately. Technologies still make several advancement to enable the simultaneous procedure of breast augmentation and mastopexy with a lower risk and medical complication. This advancement, named SAM—stands for simultaneous augmentation mastopexy, includes invaginating and tacking the tissue as the first step. It enables surgeon to previsualize the final result of the surgery before creating any kinds of incision to the breast.

Contraindications

Although most mastopexies are safe, there are certain contraindications appear in some surgical process. These contraindications include aspirin, tobacco smoking, diabetes, and obesity. Surgeon evaluates the fit of a woman who wants to undego a breast lift procedure after explantation, especially for woman with encapsulated breast implants. This facilitates assessment of the real level of ptosis exists in the explanted breasts. Moreover, for women with a high risk of breast cancer development (both primary or recurrent), histologic architecture of the breasts may be altered after mastopexy. Changes of tissue may be interfered with detailed MRI detection and treatment of cancer. In this case, the risks and benefits of doing a mastopexy will be discussed by the surgeon specifically.