Zena writes:

<I have a client with breast implants placed in about 5 years ago. She states
that she previously was slightly less than an A cup.

 

She is 5 days pp and she has had all normal breast/nipple changes and growth
during pregnancy and has started lactogenesis II yesterday.

 

My concern is that she was told that the implants were placed under the
muscle, but I can feel her implant in both breasts very distinctly just
under a layer of skin on the underside of her breasts.>

Your post made me wonder about whether at 5 days there might be more edema perhaps behind the implants than on top, perhaps making them "stand out" from the chest wall behind the muscle??. This might be an opportunity to gain more insight to share with all of us by observing closely and correlating it with her history. Might it be possible for the implants to somehow obstruct or interfere with some of the lymphatic drainage?. I think it might be especially important in such a situation to utilize gravity, and especially "laid back" positions to utilize the weight of the baby's head to help facilitate a deep latch.


Did this mom have more than 2000-2500 c.c. IV fluid during any one 24 hour period?? Did she have several days of IV fluid before birth for any complication such as pre-eclampsia or threatened premature labor? Did she have a long pitocin induction or augmentation? Or did she perhaps have many hours of IV pitocin after birth to keep the uterus tight to prevent hemorrhage, a higher risk when the uterus had either a large baby or multiples. IV fluid in excess of physiological needs is often temporarily stored in the interstitial tissue all over the body, including and sometimes, especially, in the breast tissue. I wonder if the implant will be as palpable after 10-14days when better fluid balance is achieved????


You describe her history as "previously . . . slightly less than an A cup." Cup size is rather vague as an objective measure of the actual amount of glandular tissue, as some people have less fatty tissue in the breast than others, but this may or may not have any accurate bearing on the number of ducts that would each develop their own lobes, lobules and terminal ductal lobular units during pregnancy, sometimes moreso with subsequent pregnancies, etc. etc.


OTOH, if there were actual insufficient glandular tissue to begin with, the potential for lower milk making capacity calls for careful observation of the baby's weight, etc. and more intensive stimulation (more frequent milk removal etc.) of the milk making tissue she has, regardless of questions about the location of the implant.


BW, this is a good place for me to reinforce one of my recommendations in regard to RPS. I recommend that a professional NEVER TAKE THE MEDICAL RISK of PERSONALLY PERFORMING RPS (not shouting, just the only way I know to emphasize on Lactner) on a breast with an implant in it. 


However, I think it is certainly important to explain the importance of a soft areola to the mother. If fingertip expession cannot soften the areola sufficiently to help latching, then explaining how to do RPS gently on herself if she desires to try, gives the mother the choice to decide whether to use it. Perhaps (self-applied) RPS might be even more important for her due to the overall increased "tightness" of her tissues when any extra swelling is present.  


Just some questions/thoughts that popped into my sometimes seemingly one-track mind;-)


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

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