Brian D. Rinker, MD, Melissa Veneracion, BS, and Catherine P. Walsh, BS

• INTRODUCTION:

Breastfeeding has many indisputable health benefits in early childhood, however rates of breastfeeding are low in many industrialized and developing countries (1).  In surveys conducted by international health-promotion organizations, one of the most frequent reasons cited by women for electing not to breastfeed is fear that lactation would have a negative impact upon the appearance of the breasts (2-4).  This notion is strongly disputed by pediatricians and lactation experts, but is widely held by women and seems to cross cultural and socioeconomic boundaries.  Despite strongly-held opinions on both sides of the issue, there is little or no objective data in the literature to either support or refute a detrimental effect of breastfeeding upon breast aesthetics (5).  The purpose of this study was to review a large population of healthy postpartum women presenting for aesthetic improvement of the breasts to identify risk factors for the development of breast ptosis after pregnancy, and to determine whether breastfeeding has an adverse effect on breast shape.

• METHOD: 

This study was approved by the sponsoring institution’s Review Board for research involving human subjects.  A retrospective review was conducted of all patients who presented to the plastic surgery clinic at the University of Kentucky between 1998 and 2006 in consultation for breast augmentation or mastopexy.  Clinic charts were accessed to obtain demographic data, medical history, and BMI.  Patients were contacted via telephone and asked a battery of questions regarding pregnancies, breastfeeding history, weight gain or loss, perceived impact of pregnancy upon breast size and shape, and smoking history.  Standardized preoperative photos were reviewed to determine the degree of preoperative breast ptosis, per the Regnault classification (6).  Women who were nulliparous at the time of the consultation were excluded, as were women who had a history of a non-pregnancy-related weight loss of more than 50 pounds.  A multivariable logistic regression analysis was performed, using degree of breast ptosis as the dependent variable and each of the following independent variables: age, number of pregnancies, history of breastfeeding, duration of breastfeeding, BMI, pre-pregnancy bra cup size, history of smoking, and weight gain during pregnancy, to determine which factors were associated with an increased degree of breast ptosis.  Statistical significance was defined as p<0.05.

• RESULTS:  

132 patients were successfully contacted.  93 patients had one or more term pregnancy prior to the initial consultation (median 2).  51 of these patients underwent breast augmentation alone, 15 underwent mastopexy alone, and 27 underwent augmentation and mastopexy.  The mean age at surgery was 39 years (range 22 to 53), and 54 patients (58%) gave a history of breastfeeding one or more children.  The duration of breastfeeding ranged from 2 to 25 months, with a mean of 9 months.  The mean age at surgery in the breastfeeding group (41 years) was not significantly different from the non-breastfeeding group (37 years).  Weight gain during pregnancy ranged from 5 kg to 45 kg (mean 19 kg).  36 patients (39%) gave a history of smoking.  An adverse change in breast shape following pregnancy was described by 51 respondents (55%).  27 respondents (29%) reported no change in breast size following pregnancy.  21 (23%) reported that their breasts became smaller, and 9 (10%) reported that their breasts became larger.  Upon logistic regression analysis, age, BMI, number of pregnancies, larger pre-pregnancy bra cup size, and smoking history were identified as significant independent risk factors for an increased degree of breast ptosis.  A history of breastfeeding was not found to be an independent risk factor for breast ptosis, nor did the risk of breast ptosis increase with increased duration of breastfeeding. Weight gain during pregnancy was also not found to be a significant predictor for breast ptosis.

CONCLUSION:  

These findings support the assertion of pediatricians and lactation specialists that breastfeeding does not adversely affect breast shape.  A history of breastfeeding was not found to be associated with a greater degree of breast ptosis in patients presenting for post-pregnancy aesthetic breast surgery.  Age and cigarette smoking, both of which are associated with a loss of skin elasticity, were found to be positive predictors for breast ptosis, as were larger pre-pregnancy bra cup size and number of pregnancies.  Whereas breast ptosis appears to increase with each additional pregnancy, breastfeeding does not seem to worsen these effects.  Expectant mothers should be reassured that breastfeeding does not appear to have an adverse effect upon breast appearance, beyond the effects of pregnancy alone.

REFERENCES

• Work Group on Breastfeeding. American Academy of Pediatrics.  Breastfeeding and the use of human milk.  Pediatrics 100:1035-1039, 1997.
• Barnes J, Stein A, Smith T, et al.  ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.  Extreme attitudes to body shape, social and psychological factors and a reluctance to breast feed.  J R Soc Med 90:551-559, 1997.
• Foster SF, Slade P, and Wilson K.  Body image, maternal fetal attachment, and breast feeding.  J Psychosom Res.  41:181-184, 1996.
• McLennan JD.  Early termination of breast-feeding in periurban Santo Domngo, Dominican Republic: mothers’ community perceptions and personal practices.  Rev Panam Salud Publica. 9:362-367, 2001.
• Pisacane A, and Continisio P.  Breastfeeding and perceived changes in the appearance of the breasts: a retrospective study. Acta Paediatr 93:1346-1348, 2004.
• Regnault P.  Breast ptosis: definition and treatment. Clin Plast Surg 3:193-203, 1976.