It has been said that motherhood changes everything. And for most women, everything includes the breasts. But the effects of pregnancy and breast-feeding on breast size, shape and firmness are not irreversible.

    “Most postpartum women experience some sagging, clinically known as ‘ptosis,’ along with a change of breast shape,” says Dr. Michele Koo, a plastic surgeon with Aesthetic Surgery Institute. “Some women actually increase the size of their breasts, while others lose significant volume and firmness.”

    The amount of ptosis and loss of fullness, which creates a drooping appearance, depends not so much on the original breast size but on the amount of weight gain and loss during and after pregnancy, Koo says. “It is extremely rare that breasts will return to their pre-pregnancy size and shape.”

    Although breast-feeding is known as a healthy activity for mothers and infants, the rigors of nursing a baby may contribute to skin laxity and loss of elasticity, making breasts more likely to sag. However, “the length of time of breast-feeding or the number of times a woman breast-feeds really does not affect the ultimate shape and size of the breasts,” Koo says. “Volume and shape change is determined more by the amount of fat that a woman has in her breasts and her genetics.”

    Women who are concerned about postpartum breast changes have many options. “The best cosmetic solution depends on the issue at hand,” says Dr. Judith Gurley, a plastic surgeon who practices in Chesterfield.  “If the concern is simply deflated breasts with good nipple position, then breast implants can round out and fill the breasts,” she says. “If floppy, low-hanging breasts are the issue, and the patient is satisfied with the existing volume, sometimes a lift alone will rejuvenate them. Often, a lift with an implant is nice to enlarge, lift and add more fullness higher on the breast, producing more cleavage.”

    Women need to wait at least three months after weaning their baby before they begin planning surgical breast enhancements. Waiting six months after childbirth or the end of breast-feeding, whichever comes last, allows weight and breast size, shape and position to stabilize.

    “Women who’ve had implants and/or breast lifts can usually nurse subsequent babies successfully,” says Dr. Paul Rottler, a plastic surgeon who practices in Kirkwood. “We take measures to avoid damage to nerves, breast tissue and milk glands during procedures. An implant goes behind the existing breast tissue, while a lift reduces the skin envelope surrounding the breast and repositions it on the chest wall. Neither procedure should interfere with milk production or breast-feeding.”

    Even though breast-feeding is possible after breast enhancement surgery, Rottler points out that women who become pregnant and lactate after these procedures may experience some degree of cosmetic breast change similar to those that occurred with the previous pregnancy. However, this risk doesn’t stop many women who are concerned about their postpartum appearance, Rottler says. “Many women are not happy with their breasts after their first pregnancy and want to have them improved as soon as possible.”

    Rottler adds that repeat procedures are possible, although wearing supportive bras and practicing good breast self-care help most women maintain their appearance. “Having any sort of breast procedure tends to increase a woman’s awareness of the importance of breast health,” he says. “And having healthy breasts is the most important thing.” 

Check out our March 6 issue for part two of our series, Shaping Up After Baby.