Do mothers with breast implants have an increased risk for mastitis or plugged ducts?

Risk of Mastitis and Plugged Ducts in Mothers with Breast Implants

Mothers with breast implants do have an increased risk for mastitis and plugged ducts due to potential interference with normal breast tissue architecture and milk ducts.

Anatomical and Physiological Considerations

Breast implants can affect lactation and increase the risk of milk stasis problems through several mechanisms:

• Disruption of breast tissue: Surgical procedures for implant placement can sever branches of the fourth intercostal nerve or damage nerve endings in the nipple-areolar complex, reducing sensation and potentially affecting the suckling reflex 1

• Physical pressure effects: Implants, especially those placed in a subpectoral location, can compress breast tissue and milk ducts, potentially leading to milk stasis 2

• Surgical complications: Post-surgical issues like capsular contracture can distort breast architecture and further impede milk flow 1

Risk of Lactation Complications

Mastitis Risk

Mastitis can occur in women with breast implants due to:

• Milk stasis: When milk flow is obstructed by implant pressure or surgical scarring, it creates an environment conducive to bacterial growth 2

• Infection susceptibility: The presence of foreign material (implant) may increase infection risk, with studies showing breast implant infections occur in approximately 2.0-2.5% of interventions 3

Plugged Ducts Risk

Plugged ducts are more common in women with implants due to:

• Altered duct architecture: Surgical procedures can distort normal milk duct pathways 1

• Milk stasis: The spectrum of maternal hyperlactation syndrome includes milk stasis and blocked ducts, which may be exacerbated by implants 4

Specific Concerns by Implant Type and Placement

1. Implant placement:

   • Subpectoral placement may cause more pressure on glandular tissue
   • Subglandular placement may directly interfere with milk ducts

2. Incision location:

   • Periareolar incisions pose higher risk of severing milk ducts and nerves
   • Inframammary or axillary incisions generally preserve more ductal architecture

Management Considerations

For mothers with breast implants experiencing milk stasis issues:

• Therapeutic breast massage has been shown to significantly reduce breast pain associated with milk stasis (from 6.4 to 2.8 on a 10-point scale, p<0.001) 5

• Proper breastfeeding techniques to ensure complete breast emptying

• Early intervention for signs of plugged ducts to prevent progression to mastitis

Reported Concerns

Nearly half (46%) of adverse event reports to the FDA regarding breast implants described actual problems with breastfeeding or expressed concern about implants interfering with breastfeeding 6

Prevention Strategies

For women with breast implants who are breastfeeding:

• Regular and complete breast emptying
• Prompt attention to any areas of tenderness or firmness
• Proper positioning and latch to maximize milk removal
• Awareness of early signs of plugged ducts or mastitis

Important Caveats

1. Individual variation: Not all women with implants will experience lactation difficulties

2. Surgical technique matters: The specific surgical approach used for implant placement significantly impacts future lactation success

3. Time since surgery: Complications may develop years after implantation, with two-thirds occurring in the acute post-operative period but some developing much later 3

4. Monitoring for infection: Women with breast implants should be vigilant for signs of infection, which may present differently than in women without implants

Women considering breast augmentation who may want to breastfeed in the future should discuss these risks with their surgeon and consider surgical techniques that minimize disruption to milk ducts and nerves.