Nipple incisions are most likely to cause a problem, but other incisions also played a role. A study by Dr. Sara Strom and others at the University of Texas M.D. Anderson Cancer Center looked at nursing rates among 46 new moms who had previously received saline-filled implants. Of those women, 28 chose to breastfeed their baby, but 11 or 39 percent had problems doing it. Eight of those 11 who attempted breastfeeding attributed their inabilities to implants. Seven of the eight had a periareolar incision.

"What I tell my patients is basically any surgery on the breast whether it's breast implants, breast lift, breast reduction, even a breast biopsy in this day and age, I cannot guarantee their ability to breastfeed; therefore if that is an extremely important issue for you, then don't have the surgery," says Roberta Gartside, MD, FACS, a board certified plastic surgeon in Virginia, and spokesperson for the American Society of Plastic Surgery.

"Implants go behind the muscle or behind the breast, so in terms of disturbing breast tissue or the duct structure, women should be able to breastfeed after having implants," Gartside says. But if a surgeon uses an approach that goes at or through the nipple there may be interference with the ability to breastfeed. The majority of surgeons, Gartside adds, either use an incision at the edge of the areola or at the edge of the breast, and both of those usually won't cause a problem.

Soccer Mom Surgery
Despite myths that implant surgery is mainly for the for 18- 20 year-old crowd, the average age for implant patients today is more like 35. Gartside says these are soccer moms who've already had and nursed their kids.

Still, the duct being cut is a risk when having augmentation. There are also occasions when breast lift is done at the same time as an enlargement. Allen Rosen, MD, board certified plastic surgeon and assistant clinical professor in the department of plastic surgery at the University of Medicine and Dentistry of New Jersey, as well as spokesman for the American Society of Plastic Surgery, says when a lift is done at the same time as augmentation we divide the breast tissue and therefore cut through some ducts, but even in those patients, they usually don't have a problem breastfeeding.

"I think the breastfeeding issue relates mostly to patients with reduction surgery where the entire breast is really taken apart and put back together and the entire ductal tissue is removed, but generally with augmentation it has no effect on breastfeeding," says Rosen.

Rosen stresses that even if small cuts in ducts are made during augmentation, other ducts are left in tact, which should be enough to make breastfeeding a possibility.

Mind over Boobs
Having breast implants may deter women from attempting to breastfeed, according to Strom's study. When asked about the main reason they didn't attempt to breastfeed their babies, implanted women who chose not to say they feared they wouldn't have enough milk or they'd be other problems due to their implants.

Unfortunately, that's a misnomer. Rubina Mason, RN, a certified lactation consultant in the District of Columbia and consultant on the board for Lansinoh, the oldest breastfeeding product company, says women should try to breast feed regardless of implant surgery. "A lot of mothers who have augmentation will have the same issues that moms who haven't had surgery have. But they tend to believe it's because of their implants," says Mason. When in fact, reduced flow, hormonal problems, and other common issues apart from breast surgery are to blame.

In reality Mason says having implants is not a reason not to try. Even if a woman knew there was nerve or milk duct damage done during her surgery, she still could effectively nurse. Mason had a client who had a duct injury to one breast but successfully breastfeed three kids from the other breast.

And if you are a twenty-something pre-kids woman desiring augmentation, talk to your surgeon about the approach that will be used. "It's usually moms who have scars that are close to the nipple that are the ones who have difficulty," says Mason. Typically, those are the incisions that can damage the milk duct or nerves. To discuss: the incision site, approach to surgery, and realistic odds of being able to nurse later. If a woman has an implant and she has sensation in her breast and in her nipple, she can usually nurse without a problem. If she does have a loss of sensation, that may be an indication of some nerve damage that could interfere, yet she would need to try before ruling it out. Mason recommends talking with a lactation consultant for any breastfeeding problem-including nursing with implants.

So to clear up the mixed messages: Mason advises requesting your incision not be through the nipple. Gartside stresses that if retaining the ability to breastfeed is a deal breaker, delay augmentation post baby. Rosen says there generally isn't a problem. Aren't you glad you wanted to know the truth?

Food For Thought
If you're unable to breastfeed after implants, a California based company (www.certifiedhouseholdstaffing.com) offers wet nurses, women with milk for hire to the tune of about a $1000 weekly. The majority of their clients are women who have undergone breast augmentation and have difficulty nursing. But child experts warn using a wet nurse can be a loaded gun. There's infection since viruses can be transmitted through breast milk, as well as psychological repercussions as baby bonds with her breast feeder and could be traumatized when the wet nurse relationship ends.

Wet nurses were common in upper-class households in the US and Europe, particularly France, until the late 19th century, when formula was not widely available. But the practice fell out of favor with advent of formula and the social stigma that women who wet nursed abandoned their own babies for money.