Over 300,000 women undergo breast augmentation every year by plastic surgeons alone in the United States. It is an excellent operation for the proper candidate, and many women only regret they didn't do it sooner. The vast majority of patients who undergo this surgery are younger women before they have children, and breastfeeding is a concern for a large segment of women who are considering implant-based surgery.
A breast augmentation can be performed through several different incisional options: areolar, breast crease, armpit and belly button. Most surgeons only use the areolar (around the pigmented part of the nipple) or breast crease incision because the outcomes have been shown to be more successful from these approaches versus the other options. There is no wrong choice. However, some incisions allow for more control and better results with certain surgeons.
Concerning breastfeeding in general, it is essential to keep in mind that not all women can breastfeed their infants. There are some different reasons for this to occur and frequently the specifics are not known or identified until the patient attempts to feed their child. This is termed a "low milk supply" and can be the result of several underlying causes:
Fortunately, this is a very small percentage of most new mothers. Some medications can result in low milk supply, and rarely the baby may have a metabolic or functional issue that impacts their ability to breastfeed.
Despite the proximity to the nipple and areola, the periareolar incision does not bring with it increased the risk for the diminished sensation of the nipple or an increase in the risk of breastfeeding problems after surgery. The reason for this is that the nerves and breast ducts enter the nipple from below, much like the roots of a tree. Thus, staying on the periphery of the areola, an experienced surgeon can avoid the critical structures located immediately beneath the nipple.
That being said, there is no way for a surgeon to see beneath the skin or even formally identify the deeper structures of the breast with the naked eye. This, therefore, does not eliminate all risk, but it can significantly improve the outcome for most women.
Any time we operate on the breast there is a risk to the underlying structures of the milk-producing apparatus due to inadvertent injury or uncontrolled scar contracture that may alter the shape of the breast ducts or tubules where the milk is produced. Care is typically taken to ensure that surgery is performed in a manner that will not impair a patient's ability to breastfeed.
Scar formation, however, is a process that gradually occurs throughout weeks to months after the procedure is complete. Thus, there is a small chance that the scar will kink the ducts effectively blocking the milk from reaching the nipple and therefore a child. This is very rare and not a concern for many women. If a breast reduction or lift is performed in conjunction with the augmentation, there is a small increased risk of problems breastfeeding due to the removal of tissue to help reshape the breast. Fortunately, most women who undergo a lift are not considering additional pregnancies in the future.