Erin,  You have asked many thought provoking questions, without 
straightforward answers!  
As you know, For the past 12 or so years, only saline implants have been 
available, so most women now have saline (I know they still have a 
silicone coating).
A detailed history as to WHY the mother has implants is very important.  
She may have had little to no mammary development (which could explain no 
or low milk supply not related to the implants) despite excellent 
management.  Also, I have worked with former models that actually have 2 
implants per breast for fullnes.  They have a great milk supply, but 
repeated bouts of mastitis (breast infections) have them wean quickly.  
There is no where for the milk to go!  The implants are in the way.   
I have personally seen what you found in the literature as far as where 
the incisions are placed-moms with aereola incisions often have more 
difficulty.  They are more sensitive to latch and their nipples tend to be 
flatter, making it more difficult for the baby to latch from the 
beginning.  
I have read the conclusive studies that state the amount of silicone a 
baby will receive with breasfeeding from a mom with implants is well worth 
the benefits of breastmilk, and the amount the baby will receive is no 
more than any baby gets from his/her vaccines as all needles are coated 
with silicone as well as many infant "colic" drops contain silicone.
I have been a board certified lactation consultant since 1990, and I feel 
very comfortable recommending a mom with implants breastfeed her baby. The 
esphogeal peristalsis info was not conclusive, and the AAP feels 
breastfeeding should be recommended.  Hope this helps.
Catherine Katz,RN,IBCLC,RLC 

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