By Dana Villamagna
Web Exclusive - April 4, 2007
In November of 2006, the Wall Street Journal ran a front-page article titled "Cosmetic Change: Breast Implants Made of Silicone Win FDA Backing."
Heralding the return of silicone breast implants, the article also revealed that the plastic surgery industry is expecting a major spike in profits from the huge market of women, particularly post-breastfeeding moms, who have been waiting to go under the knife for these new, improved breast implants.
According to Dr. Roxanne Guy, a plastic surgeon quoted in the article, of the nearly 300,000 women seeking implants annually, the most common customer is a "married woman in her mid-30s who is finished having children and breastfeeding and now 'wants to get back what was lost.'"
As I read that, I laid the newspaper down on my lap (reaching over the toddler nursing on it, of course), and thought back to a time in my life when I would have agreed with her. Then I pondered the changes in my own attitudes about my breasts over time.
The year was 1991 and I was a young, college-age woman when the ban on silicone breast implants went into effect. I had seriously been considering undergoing breast augmentation surgery, due entirely to poor body image. I had an uncomfortable disdain for my breasts which weren't Pamela Anderson-sized. But the bad publicity surrounding health problems in women with the silicone implants and the subsequent FDA ban provided a reality check, and I resigned myself to a life with what I considered incorrectly-sized breasts.
I now look back with gratitude for the 15-year ban, during which time I have given birth to and breastfed my three children. As a result, I have developed a deeply personal appreciation for my breasts as they were made, and for their biological purpose: to feed and grow tiny babies into healthy, active children. I regret that today's young women who feel the social pressure to be large-breasted won't be given that same opportunity to grow up that the FDA ban provided me before they decide whether to go under the knife, and before they get to see the inherent value of their own natural breasts.
As a trained volunteer breastfeeding counselor, I have received calls for help from new mothers who have had prior breast augmentation or reduction surgery. Along with the difficulties they are calling about, these moms report not having had a clear understanding of the possible later complications that their earlier surgeries could pose for breastfeeding.
The good news for these women is that it is possible for many women who have breast implants or reduction surgery to breastfeed. That's good news for baby too, because research shows that human milk is still best, even with the chance that the baby may ingest silicone from the implants. In its official statement on breast implants and breastfeeding, the American Academy of Pediatrics (AAP) notes that researchers have found that infant formula and cow's milk contain levels of silicone more than 10 times higher than the milk of mothers with implants.The AAP's Committee on Drugs, which released the statement in 2001, said current evidence does not justify "classifying silicone implants as a contraindication to breastfeeding."1
While breastfeeding is possible for women who have undergone breast surgery and is safe for their babies, it is often difficult. Incisions must have been made in such ways to maintain duct integrity, and significant scarring to the breast tissue cannot occur if the possibility of breastfeeding in the future is to be preserved. La Leche League's Breastfeeding Answer Book states that: "In one study (Neifert 1990) researchers found that women with incisions around the edge of the areola were nearly five times more likely to have insufficient milk than were those without surgery."
Elective breast surgery can present one more set of unfortunate and avoidable hurdles to breastfeeding among the many others in our current social climate. For example, in our breast-obsessed American culture, it's amazing to me that we have such a stigma about discreetly breastfeeding babies in public, when at the same time we send messages to our young women that their breasts aren't attractive unless they're big enough to be the first thing everyone notices about them upon entering any room. In America, instead of "Large Breasts Are Best", "Breastfeeding Is Best," should be the message, as it is in countries like Norway, where initiation rates hover at 99 percent2 and women breastfeed their babies in public without hesitation.
As to Dr. Guy's assertion that I have "lost" something that I need to get back": if she is referring to the fact that my breasts are more saggy than they once were, that's a fact. But in my non-medical, common sense opinion this is due the numerous changes of the childbearing years, as well as to gravity and the normal aging process that every woman will undergo—not solely or even mostly due to breastfeeding.
In any event, I wouldn't say the sag is even a loss compared to the priceless gifts breastfeeding has given to me: a close relationship with my children, confidence in the ability of my body to nourish and nurture my babies and toddlers, long-term protection against female cancers, such as breast and ovarian cancers, 3 and, yes, an enhanced —not lost—body image, including my breasts. Breastfeeding has made me a more confident, self-affirming woman. What a surprising gift to oneself, especially when breastfeeding is considered by the culture at large to be such a sacrifice on a mother's part!
What's truly ironic is that the natural experience of breastfeeding, the very thing that could help to rid a woman of body image problems related to her breasts, could be hindered by the artificial option of breast implants.
While breast implants clearly serve a role in providing reconstruction for women who have had mastectomies, I am saddened for the millions of women—young women, in particular—who may make this decision without enough information, life experience or appreciation for their own breasts. How many young women have the foresight to consider later breast-feeding complications when consenting to breast augmentation prior to becoming a mother? I know I wouldn't have. They may be making a counterproductive decision in the name of self-image and undergoing a medically unnecessary procedure.
After reading that Wall Street Journal article, I wanted to shout a thanks to the FDA for its silicone implants ban 15 years ago. And I hoped Dr. Guy was wrong about the typical profile of today's augmentation patient. Most of all, I wished that more post-breastfeeding women will take pride in what their bodies have done and feel confident in their amazing breasts because of breastfeeding, not in spite of it. I know I do, and I will.
1. American Academy of Pediatrics Committee on Drugs, Policy Statement, "The Transfer of Drugs and Other Chemicals into Human Milk," Pediatrics 108, no. 3 (September, 2001): 776-789; http://aappolicy.aappublications.org/...pediatrics;108/3/776
2. Dr. Joceline Pomerleau, Development of a Global Strategy on Infant and Young Child Feeding, Table 5.1 Norway Statistics, World Health Organization, UNICEF, Regional Office for Geneva (2001): 12; http://www.euro.who.int/document/E74173.pdf
3. Jay Moreland, MD and Jennifer Coombs, PA-C, "Promoting and Supporting Breast-feeding," Table 2 Benefits of Breast-feeding, American Family Physician, (1 April 2000): http://www.aafp.org/afp/20000401/2093.html
Dana Villamagna, MSJ, is a writer and La Leche League leader in Wisconsin.