Barbara:
Ditto to all your comments re. breastfeeding and implants. I'm happy to
share any information re. the study with you. The data was obtained from the
client records that we use in our lactation program. We have always asked
about previous breast surgery, however, the information we ask the mothers
for has been expanded on through the years to include placement of implant
(either behind the glandular tissue or behind the muscle), type of incision
utilized, any loss of nipple sensation following surgery, problems with the
implants themselves (i.e. contractures), and subsequent procedures (i.e.
closed capsulotomy). As you mentioned, periareolar incisions are NOT RARE,
as seen from the sample in the study ( 11 or 41% of the 42 mothers studied).
I might add that the comments made be Dr. Little do not surprise me given
the lack of research regarding this issue. The bulk of literature I was able
to find during my investigation on lactation and implants in medical
journals was the SIDE EFFECT of spontaneous lactation following breast
augmentation surgery. Now explain to me why it is so hard to believe that
manipulation of the nipple-areolar complex and surrounding glandular tissue
can effect future lactation performance when it has been well documented
that these procedures can spontaneously bring on milk production in a
nulliparous woman. What do you say to that Dr. Little!

One other comment on your most recent post, Barbara. The reason that you may
have seen some success with lactation in women with periareolar incisions
might be due to the actual location of the incision around the areola.
Farina et al studied the nerve supply and changes in nipple sensation after
augmentation mammoplasty. They determined the precise course of the lacteral
cutaneous branch of the fourth intercostal nerve and offered suggestions for
preserving sensation in the nipple-areola complex after surgery. They
determined that the nerve went into the left mammary gland at the 4 o'clock
position and the right at the 8 o'clock position. Based on these findings,
they modified the incision for the periareolar approach to a "10 to 5
o'clock" and "7 to 2 o'clock position. Because of this modification, post-op
nipple sensation was not decreased. Could this also prevent disruption of
the ductal and nerve supply to this area to preserve lactation? Not sure,
but it is something to consider.