From the Guidelines
Breastfeeding mothers can continue to breastfeed normally after receiving cosmetic Botox injections, as the current evidence suggests that botulinum toxin is unlikely to pass into breast milk in significant amounts. The molecular weight of botulinum toxin (150,000 daltons) is a key factor in this assessment, as medications with a molecular weight >800 daltons are less likely to achieve clinically relevant levels in breast milk 1. Additionally, the toxin is administered in very small doses for cosmetic purposes and is believed to remain localized at the injection site with minimal systemic absorption.
Some key points to consider include:
- The lack of systematic research on whether botulinum toxin enters breast milk 1
- The few reported cases of breastfeeding women with botulism, where neither C. botulinum nor botulinum toxin were identified in breast milk, and the infants did not develop any signs or symptoms of botulism 1
- The molecular weight of botulinum toxin, which might prevent its passage into breast milk 1
- The fact that the toxin would likely be inactivated in the infant's digestive tract even if small amounts were present in breast milk
As a precaution, some healthcare providers may suggest waiting 2-4 hours after injection before breastfeeding, though this is not based on strong evidence 1. It is essential for mothers to inform their cosmetic provider about their breastfeeding status and discuss any concerns with both their cosmetic provider and the infant's healthcare provider before proceeding with treatment. The current recommendation is based on the available evidence, including the study published in the MMWR Recommendations and Reports in 2021 1.
From the Research
Guidelines for Cosmetic Botox Use in Breastfeeding Mothers
- There are limited studies on the risk of botulinum toxin transmission through breast milk, but available data suggest that the risk is low 2.
- A pilot study found that botulinum toxin was detectable in some breast milk samples, but the amounts were well below the reported lethal oral dose for an infant 2.
- The study suggests that facial botulinum toxin injections do not warrant an interruption in breastfeeding, but further studies with larger sample sizes are needed to confirm this finding 2.
Safety of Botulinum Toxin
- Botulinum toxin is considered a safe therapy for inappropriate muscle spasms, with adverse effects being typically self-limited 3.
- The greatest concern with the use of botulinum toxin is the formation of blocking antibodies, which can lead to non-response to subsequent treatment, but the prevalence of resistance is less than 5% 3.
- Most complications associated with the aesthetic use of botulinum toxin are few and anecdotal 3.
Breast Milk and Infection
- Breast milk is not an important mode of transmission for most maternal viral infections, and continuation of breastfeeding is in the best interest of the infant and mother 4.
- Maternal bacterial infections rarely complicate transmission of infection to infants through breast milk, and temporary cessation of breastfeeding or avoidance of breast milk is only necessary in a few situations 4.
- Antimicrobial use by the mother should not be a reason to stop breastfeeding, and alternative regimens compatible with breastfeeding can be chosen to treat the mother effectively 4.
Cosmetic Botox Use
- Botulinum toxin type A (Botox) is approved for the treatment of glabellar wrinkles and has been used for cosmetic purposes, including the treatment of movement-related facial lines and platysmal bands in the neck 5.
- The use of botulinum toxin injections for cosmetic treatment has been reviewed, including injection procedures, efficacy, and potential complications 5.
- Recent developments in the use of botulinum toxins for the treatment of palmar and axillary hyperhidrosis have also been described, comparing type A and type B results 5.