>>Now for my question.  Are there any contraindications to breastfeeding with
breast implants?  The LC I work with thought she read somewhere that they
caused problems with the esophagus in the baby. Thanks in advance for your
help.<<

The issue that your LC friend recalled actually has to do with silicone
filled breast implants specifically, and not all implants. I have a couple of
preliminary articles that discuss correlations between esophageal
schleroderma and breastfeeding from moms with these implants; conclusion: "A
relationship appears to exist between breastfeeding by mothers with silicone
implants and abnormal esophageal motility. Studies evaluating larger numbers
of children are needed to determine the extent of the risk." (JAMA. 1994,
271:213-216)

Another JAMA article from that edition, "Silicone Implants and Esophageal
Dysmotility: Are breastfed infants at Risk?" comments, "Should US physicians
join their European colleagues in recommending that mothers with silicone
implants refrain from nursing their infants? Clearly, more data are needed
and indeed are beginning to appear."........ " The AMA's council on
scientific affairs has estimated that it will be many years before controlled
trials determine if silicone gel breast implants are associated with an
increase in immune disorders among the recipients themselves. The benefits of
breastfeeding, including the infant's reduced susceptibility to infections
diseases and promotion of maternal infant-bonding, are well established,
while the potential adverse effects reported by Levine and Ilowite among
breastfed children of silicone implant recipients are yet to be confirmed."

From "FDA Backgrounder" Aug. 91- Important Information on Breast Implants -
7. Is  there a risk to nursing infant from the polyurethane coating? \
At this oint, there has been one report that a trace amount of TDA from
polyurethane may have been found in 1 out of 3 samples of breastmilk from one
woman. ... FDA is requirign the mfr of the implant to conduct further studies
on breastmilk. Studies will also be conducted on TDA levels in blood and
urine."

I also heard a spokeswoman for Command Trust, an anti-implant activist group,
address this topic. As a "victim" of implant surgery gone awry and as the
collector of "disaster" info, she has strong hesitations for a woman to
breastfeed with silicone implants. LLL takes a differing standpoint, and the
two do not agree.

My own personal conclusion is to assess the individual mother and share my
available information. I want to know if she has had any complications with
the implants, especially ruptures. I want to know if her implant has a
polyurethane coating--- this is known to break down and release questionable
by-products (TDA) into the system.  If everything appears intact, then I
personally feel that breastfeeding is probably safer than ABM. If the mother
has suffered problems, however, I would want to look much further, and
perhaps recommend further testing.

I do wonder, with all of our silicone nipples and such, how much silicone is
ingested in other ways.......   and whether that constitutes a health risk or
not!

This is the most up-to-date info I have. If more has come out and someone has
it, I hope you'll share it!

-Lisa Marasco, LLLL, IBCLC
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