According to the Board of Plastic and Cosmetic Surgery, elective breast procedures are now as common as tooth extractions. Although they are growing more popular, the impact of these procedures on future health, well being and family are often not understood by the women who are having them.

Cosmetic surgery to the breast includes reductions, augmentations, lifts, symmetries (to make uneven breasts the same size and shape) and inverted nipple corrections. All of these procedures include manipulation of the breast tissue and may have possible implications on the ability to breastfeed. The impact on breastfeeding varies depending on the procedure.

According to Dr. Woody Baxt, a New Jersey plastic and reconstructive surgeon, "Women who are not able to breastfeed after a breast procedure are the exception rather than the rule. Depending upon what procedure is being done, a woman may find that her ability to breastfeed is not affected in any way."

According to the American Society of Plastic Surgeons, the most common elective breast procedure is breast augmentation. Breast augmentation is the procedure in which an implant is inserted into the breast to produce a larger breast size. The procedure is done under a general anesthesia in a clinic or hospital setting. The implant is inserted through a small incision in the lower crease area of the breast, under the nipple or in the armpit. The adipose, or fatty layer, and muscle wall is loosened away from the chest and the implant is placed inside.

Depending on the incision, an attempt to preserve breastfeeding can be successful. As is the case with a sub-mammary breast augmentation. In this procedure, the incision is placed at or near the lower breast fold. "Assuming there is no complication from surgery, there should be no interference with breastfeeding," says Dr. Keith Brandt, associate professor of plastic and reconstructive surgery at Washington University in St. Louis, Mo.

However, a peri-areolar breast augmentation is a different story. With this type of incision, the cut is made at the border of the areola and the surrounding breast skin. The lower breast ducts are cut during the surgery. "When breast implants are placed through the peri-areolar incision, there is an increased chance of decreasing the milk supply or damaging the nerves so severely that breastfeeding cannot succeed," says Ann Calandro, a lactation consultant and registered nurse from South Carolina.

Breast reduction is a procedure that reduces the size of a woman's breasts. This procedure is commonly recommended for women with extremely large breasts, which can cause back, shoulder or neck pain as well as posture problems. Breast reduction involves taking away tissue from the breast to offer a smaller, more proportioned and comfortable size for the woman. However, due to a reduction in tissue, the procedure may interfere with a woman's ability to breastfeed.

There are two variations of the breast reduction procedure. The standard involves separating all glandular tissue from the overlying skin. By removing a portion of the tissue, the size of the breast is reduced. The remaining tissue is then repositioned and the outer skin replaced. Breastfeeding ability may be reduced with this procedure. "While this maintains the communication of the glands in the breast tissue with the ducts in the nipple, it reduces the overall number of glands and there may not be enough left afterwards to produce enough milk to effectively breastfeed," Dr. Brandt says. The second technique is used in the event of unusually large breasts. In this procedure the nipple and areolar area is removed completely. The breast tissue is reduced and the nipple and areolar area is then reattached as a free skin graft. "This procedure results in the severance of all glandular ducts," Dr. Brandt explains.

That might sound like disaster for the Mom that wishes to breastfeed. Yet even after the severance of all glandular ducts, some women can still nurse. "I know moms who have successfully breastfed after reduction surgeries, even if the nipple was moved," Calandro says.

Another procedure gaining popularity is a breast mastopexy, commonly known as a "breast lift." This procedure offers women the opportunity to tighten the skin, giving the breasts a more youthful appearance. Many women, who are unhappy with the loss of skin elasticity caused by pregnancy, request the breast lift procedure.

The breast lift involves only the tightening of the skin. Therefore the underlying tissue of the breast, in which the milk ducts are found, is in no way altered or manipulated. As a result, unless complications from the procedure arise, there is no decrease in a woman's ability to breastfeed after having a breast lift procedure. "This usually involves only the removal of excess skin from the breast and leaves the glandular portion of the breast alone, and therefore should not interfere with breastfeeding," Dr. Brandt says.

Ami Custer of Asheville, N.C. is a "breastfeeding after breast lift" success story. "My husband and I had discussed having another baby, so I wanted to be sure that I could still breastfeed if we did," she says. "I talked to the plastic surgeon and he told me the risks. I had the procedure and managed to breastfeed our new baby girl without any problem."

In extreme cases, the procedure can result in much the same outcome for breastfeeding as the peri-areolar breast augmentation. "If a lift is a dramatic change, such as the breast is sagging more then 75 percent, the nipple is removed and then replaced in the center of the breast after the lift is performed." Dr. Baxt says.

There are two other elective breast procedures that women have been choosing: tattoos and nipple piercings. Although these procedures are done by trained professionals, they are not medical in nature. These procedures can impacted the ability to breastfeed.

Tattoos are created with a tool that allows a needle to inject colored dye into the superficial layer of skin. As this is an invasive procedure, there is risk of infection to both the skin and underlying tissue. Should the underlying tissue become infected, it could alter the amount of milk produced as well as the milk's clarity. "Assuming the tattoo does not become infected it should not affect breastfeeding," Dr. Brandt says. It is recommended that women do not get breast tattoos done during the period in which they are breastfeeding.

Nipple piercing is another elective procedure that is non-medical. Nipple piercing is done by injecting a piercing stud lengthwise through the nipple and exiting on the opposite side. As with all invasive procedures, nipple piercing has risks related to infection. In addition, Dr. Brandt says, "Any penetrating trauma to the nipple will cause a normal healing response of scarring. It is unlikely, but it could be enough to occlude enough of the milk ducts in the nipple to interfere with breastfeeding." As with tattoos, it is recommended that woman refrain from having a nipple piercing procedure while breastfeeding.

Whether for cosmetic reasons, health or self-expression, having an elective breast procedure may have an impact on your ability to breastfeed. If breast surgery is in your past, contact a lactation consultant for individual advice. If you are considering an elective breast procedure, but want to ensure the ability to breastfeed, discuss all alternatives with a lactation consultant or a doctor. It is possible to breastfeed after cosmetic breast surgery; Getting the proper information is the key.