Real or fake? The boob job dilemma

Whether breast augmentation may be seen by some as tacky taboo, others may marvel at the prospect, while still others just simply enjoy all the talk about boobs. While breast augmentation is by no means unheard of, understanding breast implants in relation to breast cancer and breast feeding is not the hottest topic. Regardless, of whether you are in favor of silicone, saline, or the good old fashioned all-natural, its  likely that either you or someone you know has breast implants. Please share the info.

About Breastfeeding…

ImageAs mentioned in one of my previous posts, “Breast is Best”. The American Academy of Pediatrics recommends that babies should be exclusively breast fed for the first year of life. This is not only beneficial to the nutritional intake of the infant, but breast feeding is also exceedingly beneficial to the mother as well (see my blog post for more info: https://g8rk8.wordpress.com/2011/03/26/breastfeeding-to-keep-kosher/). A common concern among women who have, or are considering breast implants, is the ability to breastfeed. ImageThe literature is varied, however, the review by Cruz and Korchin (2010) summarizes key investigations related to breast feeding success following augmentation. While there are a multitude of potential factors that could impede breastfeeding (in both augmented and non-augmented breasts), incision site remains to be a common denominator in nearly all studies. Though the differences between the periareolar and submammary approaches were minimal, these incision sites generally had the least success with breastfeeding when compared to transaxillary approaches. This is possibly due to a couple factors. First, the tissue surrounding the underside of the nipple is composed of many glands, ducts, and nerves that are involved in lactation. Damage to any of these structures can therefore interrupt the process of milk production, leading to absent or insufficient milk supply. Additionally, the periareolar incision involves severing many superficial nerves in the nipple, and is thus most often linked to decreased nipple sensation. Nipple sensation plays a crucial role in milk production; the suckling sensation produces a reflexive stimulation of the pituitary gland, with subsequent release of prolactin, an essential hormone needed for lactation (Cruz & Korchin, 2010). While it was thought that the transaxillary approach may have better breastfeeding outcomes due to reduced manipulation of breast tissue, this approach does, however, involve extensive trauma to the nerves and lymph nodes that are essential to proper mammary gland function. Another theory that has recently been suggestion for future investigation is the association of small “hypoplastic breasts,” and inadequate milk supply (Cruz & Korchin, 2010). ImageThis theory suggests that women who have difficulty breast feeding following breast augmentation are more likely to have had small, inadequately developed breast tissue prior to augmentation (thus inciting desire for surgical enhancement). Finally, placement of the breast implant is significantly related to breastfeeding ability. Typically, the implant is placed under the muscle (submuscular) or under the glands (subglandular). When the implants are placed under the glands, there is a greater chance of complications related to pressure from the implant against the glands, more discomfort during breastfeeding, and the possibility of capsular contraction (a long term complication of implants) that could potentially interfere with the breast anatomy and function of the glands.

Breast Cancer Screening…

While breast feeding with breast implants is an important topic that is left untouched by many women’s health providers, the primary intention of this blog was to discuss and bring awareness to the myths, risks, and screening tools for breast cancer in someone with breast implants. It is no secret in the health care field that breast implants pose substantial challenges to current breast cancer screening measures such as self-breast exams, clinical breast exams, and mammography. However, the greater majority of clinical investigations exploring the incidence of breast cancer following augmentation have shown little to no difference in statistics between augmented and non-augmented breast cancer patients3. In fact, some studies actually saw better cancer prognoses for patients with implants. There are several theories that have been elicited from this conclusion. This will be addressed after a review of the obstacles (booby traps?) imposed by implants on breast cancer screening. Chiefly, reduced imaging quality of mammograms is a primary concern with breast implants. Mammography provides detection of different densities in breast tissue, identifying possible tumors, which appear as radiopaque white masses  (pardon my lack of radiology expertise from that definition). This screening technique is a widely used and recommended method for the early detection of breast masses. Unfortunately, breast implants possess similar opacity to tumor masses, and can often lead to inconclusive and inaccurate results if a significant portion of breast tissue is obscured from the image.

Therefore, the more breast tissue that can be isolated from the implant, the better the likelihood of a more accurate mammogram. As mentioned previously, submuscular placement refers to implants that are placed under the muscles of the chest wall. This allows for more breast tissue to be dispersed away from the implant, and thus less opportunity for masses to be concealed. The same concept is true for self and clinical breast exams. The submuscular implant is well separated from the glandular breast tissue, and thus provides a firm “backdrop” with which to compress the breast tissue, providing greater ability to distinguish the different textures of tissue3. It is essential, however, to have an adequate knowledge of self-exam techniques, and the ability to distinguish between normal breast tissue, implant structures, and possible pathology.

Health care provider skepticism to breast implants may be related to challenges in reliable early detection of abnormal breast masses4.  However, as mentioned, several studies have had surprising results of breast cancer detection in augmented versus non-augmented breasts. Some studies found that women with breast implants often detected masses and were diagnosed at early stages of the disease, and frequently had smaller sized tumors than women without implants4.  Theories behind this concept are as follows:

  • Increased body awareness. Women who have undergone breast augmentation generally display a greater awareness of body image, identification of changes, and comfort with self assessment and examination3.
  • Increased implementation of self breast exams through the use of massage to prevent capsular contraction4.
  • Better educated about proper assessment, screening measures, and consistent follow-up.
    • Women with breast implants tend to have increased interaction and communication with surgeons and other health care providers about expectations, recommendations, and what to look out for3.
    • Women with breast implants are more likely than women without implants to have regular mammograms3.
    • Possible anatomical advantages: enhanced local immune response and surveillance due to the presence of a foreign body; compression of surrounding breast tissue leading to conservative blood distribution and reduced blood supply to growing tumors4.

In general, most of the research has shown very little other significant differences in either rate of detection, extent of metastasis, or disease prognosis amongst women with or without breast implants3. While these theories are simply just that, they do offer a firm foundation for consideration in a risk versus benefit analysis. I hope this blog has shed some light on a very unspoken issue in women’s health, and please pass on the information. I don’t feel breast implants are in any way better or worse than not having implants, but I respect and support the choice to do so if desired. As always, please take all information in this blog with a grain of salt. This is not professional medical advice, simply a casual discussion. Do not use this info as a substitute for professional medical attention.

 

References:

1Cruz, N., & Korchin, L., (2010). Breastfeeding After Augmentation Mammaplasty with Saline Implants. Annals of Plastic Surgery, 64(5): 530-533.

2Strom, S., Balwin, B., Sigurdson, A., Schusterman, M., (1997). Cosmetic saline breast implants: A survey of satisfaction, breast-feeding experience, cancer, and health. Plastic and Reconstructive Surgery, 100(6):1553-1557

3Smalley, S., (2003). Breast implants and breast cancer screening. Journal of Midwifery & Women’s Health, 48(5): 329-337.

4Deapen, D., (2007). Breast Implants and Breast Cancer: A Review of Incidence, Detection, Mortality, and Survival. Plastic and Reconstructive Surgery, 120(7):70S-80S

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Out of my element….

I am a very lucky girl. No doubt about that. I have a magnificent family and friends that care about me and all the trials and triumphs of my daily life. But because my phone has not stopped the notifications of my concerned and curious loved ones, I am going to try to keep my sanity and save myself from feeling like a broken record, and give a single recollection of the last 24 hours in this new lifestyle. Started work today as an official RN, whoop whoop. But surprisingly, I have no exciting stories about my first day of work. It was really just your typical New Employee Orientation day. Lots of enthusiastic smiles, cheesy learning activities, guest speakers, paperwork, and free lunch. Can’t complain about getting paid to chill in a nice conference room listening to inspirational speeches about what a great choice I made coming to work at Parrish. I don’t doubt for a minute the incredible learning opportunities and “Healing Experiences” that are in store for me here. Let’s just say that, I’m not sure the new job is my biggest adventure anymore….

I am trying to learn how to live with my new neighbors. And I don’t mean the people. The blood sucking mosquitoes. gnats, horse flies, no-see-em’s etc are nearly debilitating…literally drawing blood in minutes of being outside. I have always been unusually prone to getting bug bites., but this is some serious harassment. I have had to take the dog for a walk armed with protection, and I’m not referring to the pepper spray or taser that I conveniently keep to ward off creepers. No, no, now when people see me walking towards them, they cross to the other side of the street. Yes, I am that weirdo walking the funny looking dog, wearing bright red knee-high rain boots, oversized basketball shorts, and a jacket with the hood pulled tight around my face. To make matters worse, Diesel, being so excited about all the new smells and places to pee, gets so distracted he forgets that he needs to poop. I can tell–everytime I see him get ready to get in the squatting postition, he seems to catch a whiff of interest nearby. He is in canine bliss while I get devoured by insects. I LOVE my new house. I am so happy with my new home, and I can’t help but spend all of my thoughts thinking of new, creative projects and ideas for the house. Most recently, the influence of my brilliantly handy father sparked my  creativity as I attempted to rig up some extra night lights before bed (just in case I get paranoid in the middle of the night), rearranging lamps and extension cords etc to get more light and visibility…without turning on actual lights of course. Anyway, after about an hour of unplugging, replugging, and not getting anywhere, I gave up and decided to just settle with the half dozen nightlight plug-ins I started with. Despite my parents’ disagreements with my pack rat clutter, there was, surprisingly, a system to the madness. I cant seem to find anything lately. Not even important things, but simple things that are always in the way until when you need them. Like stamps. I used to keep them in the silverware drawer in the kitchen, only because they were with my groceries one day, and I put them in there so I didnt throw them out, and for months, thats where I kept stamps. Yesterday, (in my attempt at being organized) I specifically recall putting them in a designated safe place in my new office/study/guest room. This afternoon, I nearly unpacked half the house trying to remember where I put them. Similarly, out of my entire collection of random pens of every shape, size, and color that I would usually keep scattered throughout the house, the one day I am looking for a RED pen to do some editing, the only color (out of literally hundreds of pens) is black–not even a blue pen to give SOME kind of contrast. Nope. Go figure. How’s this for Murphy’s Law…I typically make it a habit to only buy wines with twist off tops instead of corks. You can probably imagine my frustration from my countless failed attempts to open a bottle of wine. Impossible. I don’t doubt it has everything to do with the constant slippery, soapy film I can’t seem to wash off my skin with the soft water around here. I tried to open a jug of milk this morning for breakfast, and couldn’t get a grip for the life of me. Or the fact that every dish I wash (and I have washed every single bowl/plate/fork and spoon I’ve used) won’t feel completely rinsed from slimey soap suds, making me feel the need to put more soap and start scrubbing again. Speaking of my cleaning concerns, as I was showering tonight I was just starting to put two and two together (about the constant soapiness and soft water) and absentmindedly realized I was trying to scrub my face with….conditioner. Is it the weekend yet???

Caesarean Deliveries and the Development of Childhood Allergies and Respiratory Issues

As medical advancements make more and more contributions to the way patients receive treatment, there seems to be an all time high in the rate of Caesarean sections amongst normal births. Reasons for this include the desire for quick, uncomplicated labor, and fears and lack in confidence regarding natural childbirth (Childbirth Connection, 2007). As a result of this increased incidences of C-sections, there has been more research exploring long-term effects of this method of birth on the children. The most significant findings have been increased rates of asthma, allergies, and chronic bronchitis amongst children delivered by c-section versus those delivered vaginally. In a retrospective cohort study, children that had been recently diagnosed in the past decade with any respiratory disorders, including allergies and dermatitis were investigated on their birth statistics, including birth weight, delivery method, gestational age, and maternal behaviors (Renz-Polster, 2005).  This investigation found a significant correlation between delivery by c-section and incidence of respiratory problems and allergies later in life. The pathologic process is thought to be due to the lack of microorganism exposure during the birthing process (Renz-Polster, 2005). The thought rises from the idea that decreased exposure to environmental organisms in the first few days of life leads to increased rates of allergy development; the normal intestinal flora of the newborn is generally acquired as it is exposed to organisms in the vaginal tract during the birthing process. This phenomenon is thought to be one of the most important factors contributing to this study, because it is associated with the necessary introduction to environmental organisms that leads to the development of immune system tolerance outside the sterile fetal environment (Renz-Polster, 2005). When the infant is removed by c-section, there is no contact with the maternal vaginal flora, and microbiotic exposure is experienced differently through skin contact over the next few days, with introduction of a different type and quantity of microorganisms (Renz-Polster, 2005). Furthermore, natural mechanical processes of a vaginal birth allow the expulsion of amniotic fluid from the lungs of the infant as its chest is compressed through the birth canal. In this manner, the infant’s lungs are better primed for the first breath, as opposed to during c-sections, where there is no mechanical compression of the chest, and fluid removal is often extracted by suction mechanisms, often leaving the infant with fluid still in the lungs, making it harder for it to begin breathing on its own.

With these findings, it is imperative that as health care providers we stress the importance of avoiding birth by Caesarean if at all possible. We need to provide out patients with the education necessary over what to expect during the birthing process, and how to appropriately manage delivery without surgical interventions. This is probably the most critical factor to implement, to explore delivery options before maternal stress and exhaustion from labor is experienced. This will lead to better informed consent, and will likely reduce the incidence of delivery by c-section. Furthermore, it is also important to inform our patients that subsequent deliveries after a c-section are often routinely performed as c-sections, further increasing the amount of risk for developing allergies and respiratory problems in the family later in life.

References:

Childbirth Connection (2007). Choices in childbirth. The New York guide to a healthy birth.

Renz-Polster, H. (2005). Caesarean section delivery and the risk of allergic disorders in childhood. Clinical & experimental allergy, 35: 1466–1472. doi: 10.1111/j.1365-2222.2005.02356.x