June
What I would want to know w/ your pt is this: did she experience
lactogenesis II, i.e. a noticeable increase in breast fullness on approx.
day 3-5. I am guessing that she did (since she had lots of colostrum and
baby regained lost weight in first 7 days). I am guessing that she
experienced increased engorgement, which I feel that pts w/ implants are at
higher risk for. If the baby was sleeping thru feeds and mother was not
expressing, I am guessing that she experienced some involution and
subsequent decreased supply. She may very well have mastitis too, as milk
stasis is a big risk factor for that.
Re implants: if the breasts were normal pre surgery and pt did the implants
strictly for cosmetic enhancement, then the breasts should have the
potential to function normally. If the breasts were very small, unusual
shape, assymetrical, etc then the breasts function may be called into
question. The next thing to consider is the incisions. Usually inframammary
incisions (under breast) and w/the implant under the muscle, would be the
best case scenario for good function. Under axilla incisions usally ok too.
The problem would be w/ areolar incisions. You can also ask about changes in
sensation whcih would be a risk factor.
Also I feel that pts w/ very large increases in breast size have implants
which may put pressure on the breast structures and of course  increase risk
of engorgement.



Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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