I have had two private questions from Lactnetters this week regarding the possible use of RPS on mothers with implants. This is the first time I have had the question asked directly although I have mentioned it as a contraindication to the use of RPS, in the JHL article and in several powerpoint presentations.


So I decided that my thoughts might also be of some interest to others on LN:

 
This is my rationale. My impression is that firmness and/or swelling of the postpartum breast without implants has seemed to be very difficult for many folks to recognize/judge/differentiate in assessments. The firmness of the postpartum breasts at any specific individual moment in time can be:

1) from increased circulation in the arteriovenous vessels (normal), 


2) from increased milk production (in cells-normal), and temporary storage (in full alveoli or ducts-normal/common/problematic) and either/both of these in combination with: 


3) excess interstitial fluid in the interstitial tissue ("third space") in the breast. 


I have observed empirically that this often begins happening with administration of more than 2000-2500 c.c. IV fluid/24 hours, beginning within 24 hours after the start of administration of more than this amount. This risk of edema formation increases with possible fluid retention due to the corollary effect on the kidneys of pitocin used for induction, augmentation or third stage management for long hours (some administration potentially lifesaving in a genuine emergency, but potentially iatrogenic in other situations.) 


Add to this the fact that an implant itself would likely cause some degree of "firmness", let alone any prenatal changes in existing breast tissue in a breast with the implant in it. 
 

Furthermore, without a surgical report which we are unlikely to have, we have to assume that the implant itself has some kind/degree of fluid in it, and that too much finger pressure on it for ??? long a time might THEORETICALLY (not yelling, just emphasizing) be capable of "exploding" the implant.


So I don't think it would be a wise action for a professional to personally perform RPS on a mother with an implant when a firm areola may be complicating latching or pumping attempts. That has been my reason for recommending against it.
 

However, even though I've never explicitly written about a possible self-help aspect, I think it would be OK to explain the benefit of RPS to soften the areola to the mother using a demo breast. After that, I would then mention this theoretical effect on the implant, and let her make the decision about whether to try RPS with less pressure for a much longer time (5+???? minutes?). 


I have found moms can immediately sense the differences in pliability through a demonstration on their own face. I have a mom use a thumb and forefinger to compress opposite sides of her own chin/jaw and then move upward to the lower lip to retest by compressing together the two sides of her lower lip to compare the pliability to the chin. The earlobe is an alternate site to compare desired pliability.  


This would give her a basis for how to gently assess the pliability of her areola just before each feeding/pumping in the early weeks (cautioning her that this swelling/excess firmness can sometime starts as late as a day or so after her discharge from the hospital!.) I would also explain the temporary benefit of a softer areola for the baby's sake (or for the sake of effective pumping). And I think it would also be beneficial to explain MER, and how RPS always triggers it within 60+ seconds (providing no nerve damage occurred with the surgery.)


Then she could choose for herself whether to very lightly and gently, and for a much longer time (5+ minutes or so???, do constant very gentle RPS on her own areola. I think her own sensations in her fingers and areola and breast would help her judge much more accurately any possible need to limit pressure than if some other person would be performing RPS on her. 


Because of her need to use her kinesthetic senses, I would recommend that she perform RPS with her own actual fingertips, and not through an ordinary cut-off nipple shown in some of my instruction sheets. 


(However, this method  using an artificial nipple can simplify RPS greatly in many other situations. Anyone is welcome to contact me privately to ask more if there are any questions about this method.)

 
The extra added few moments of pressure would still allow the gentle RPS 
                       1) to temporarily displace interstitial fluid (without near as much danger of damage to an implant) and 
                       2) to displace milk upward from the subareolar ducts enough to temporarily result in a deeply pliable 
                           areola for a longer window for latching., especially if the mother were in an antigravity position. 


However, concerning anti-gravity RPS, these moms are not likely to be the ones with pendulous breasts (unless the implant were done for  completely cosmetic reasons;-).


So that's my reasoning. 


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC       Dayton OH

 

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