Jean and all,

Interesting comments. I've wondered about this situation many times
when working with mothers with implants. I have had implants (placed
behind the muscle and prior to my pregnancies/lactations) and I
breastfed two children with them in (10 mos, ?6 yrs, respectively). I
did have excessive engorgement in those early days, and of course, RPS
was not known then. Twenty years later, I had them removed (and not
replaced). This just to show I have personal experience with them.

What I remember was the doctor instructed me (as was the standard
post-op care as far as I know) to put quite a bit of pressure on the
breasts/implants, including lying prone on them and also pushing them
from side to side. I believe twice a day for some many weeks. All this
to prevent encapsulation or strictures, as I recall. There is no
contraindication to sleeping prone, as far as I know. So, personally,
I really do not see a problem with applying gentle steady RPS to the
areola of a woman with breast implants. Certainly one could caution
the woman that undue pressure would be contraindicated. But I wonder
if NOT doing RPS may put mother at high risk of downregulating milk
supply, engorgement leading to mastitis, and of course excessive
difficulty with latching/breastfeeding, leading to premature weaning.

I am not sure how we could finally resolve this question (to do or not
to do RPS) as there might be many intervening variables to consider
(age of implants, in front of vs behind muscle, size of implants,
material they are made of????). I will say the amount of pressure I
use and show the mother to use is not out of the realm of any other
pressure that might be placed against someone's breast or chest, and I
think it would be generally safe.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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