I know I am not a pediatrician or a family practice doctor, so some may wonder why I am so focused on breastfeeding.   I am a surgeon who deals a ton with the breasts and the effects of breastfeeding.  I have heard rumblings while being a mom-around-town of women who are choosing not to breastfeed their children because they are concerned about the cosmetic effect it will have on their breasts.  I am a fan of breastfeeding.  Please see the other blogs prior to this and the results of a study which just came out.

For the hypereducated Bay Area women reading my blog, here is another pro for breastfeeding:

MUCH lower risk of SIDS.

SIDS is sudden infant death syndrome.  It affects 2,300 babies a year.  The cause is unknown.  From the sids.org site, risk factors include having a baby as a teen, less than one year between pregnancies, tobacco/cocaine/heroin use during pregnancy, and premature birth.  After the baby is born: have the crib in your room, no bedding/pillows, sleep on the back, use a pacifier, avoid respiratory infections, and do not overheat the baby.  The risk is highest between 2-4 months of age.  90% of SIDS occur in babies less than 6 months.

In Pediatrics June 2011 online edition, Hauck and researchers at University of Virgina did metaanalysis of 18 studies looking at breastfeeding and risk of SIDS.  Findings:

  • 73% reduction in risk if exclusively breastfed
  • 60% reduction in risk if breastfed for any time period
  • 45% reduction when other factors known to increase SIDS were factored out, like smoking, socioeconomic status, and sleep position.


Why does breastfeeding lead to lower risk?  Thoughts vary.  Hypothesis include:

  • Breastfed babies are more arousable during sleep
  • Fewer issues with diarrhea and respiratory infections, which may predispose to SIDS
  • Possible boost of their immunity from the breastmilk.

So, pediatricians recommend breastfeeding exclusively for 6 months and then continue to nurse for the first year, as you introduce solid foods.  So bond with your child, lose weight (anyone for an extra slice of cheesecake?), and protect them from SIDS…. Breastfeeding is sounding pretty good.

I love science.

I do a ton of breast surgery.  I have 3 kids.  I am a huge fan of breastfeeding.  How can I advise my patients about breast surgery and the relationship to breastfeeding?   I know a lot from being in practice for over a decade, and I read a lot of studies.  Every piece of information helps in the decision making.

There are women who are going to have a hard time breastfeeding.  Some of these women have had breast surgery, others did not.  Is there some way to predict who is whom?  Who will have a harder time?

A study came out in Birth, Sept 1990 looking at the influence of different factors on your ability to breastfeed a baby.  The study followed 319 women who were pregnant with their first baby who intended to breastfeed.  These women were evaluated in their last trimester for their initial measurements.  They looked at:

  • surgical incisions
  • size
  • symmetry
  • nipple protuberance (do you have inverted nipples?)
  • and the woman’s estimate of their breast increase during the pregnancy

At two visits after the first 2 weeks postpartum (all were term babies), the infants were weighed and the moms estimated how big their breasts got when their milk came in.  Breastfeeding was evaluated and help was given when there were problems, looking particularly at how to maximize the amount of milk made.

“Sufficient” milk production related to an average weight gain daily of 28.5g between visits.  If they had to supplement with formula this was noted as well. 

What was related?                                                              

  • 85% of mothers had sufficient lactation
  • 15% had insufficient lactation, despite intervention
  • 7% had some kind of breast surgery prior to their first pregnancy.  If a periareolar incision was used, these women had a 5x rate of lactation insufficiency compared to those without any surgery.
  • Insufficient lactation was significantly associated with minimal prenatal breast enlargement
  • Insufficient lactation was significantly associated with minimal postpartum breast enlargement when the milk came in
  • Inverted nipples were more likely to have lactation insufficiency (not statistically significant)


So. How can you anticipate?  If you have inverted nipples, or prior breast surgery with an incision in the periareolar area, you may have decreased milk production.  15% of women in this study had insufficient milk production, and many did not have any prior surgery or inverted nipples.  If your breasts get much larger with pregnancy and when your milk comes in, signs are good you will produce enough milk. 

What I have seen in my plastic surgery practice here in Palo Alto, where there is positive peer pressure to breastfeed, is prior surgery does not mean you can’t breastfeed.  What I found in practice and these studies is your milk production may be lower.  But any breast milk is good for you, your baby, and your bond.

Let’s hear it for the girls! 

I love breastfeeding.  We always knew it was good for your heart to snuggle and be close to your baby (awwwww.)  But now science supports it as well.  I know breast feeding doesn’t make the breasts look prettier long term (in the short term it can do wonders though).  I know as a plastic surgeon many of you think we only care about how pretty your breasts are.  And I do care what they look like, but the breasts have a purpose other than looking good in a bikini.

A new study came out in Diabetes  (and was presented by Gunderson’s team on June 6 in New Orleans at the American Diabetes Association’s 69th annual Scientific Sessions meeting).  It was a long term prospective study of 1400 patients.  In it, they looked at the benefit to mom (not babe) of breastfeeding, specifically looking at the “metabolic syndrome” of risk factors which cluster and increase your heart risk.

What increases your risk of heart disease and diabetes?

  • Abdominal obesity (the apple body shape, not pear, especially when the fat is “intraabdominal” behind your belly muscles)
  • high blood pressure
  • cholesterol (low HDL the good one, and high LDL, the bad one)
  • high triglycerides
  •  insulin resistance
  • inflammatory markers
  • a tendency to clot.


They found of these 1400 women, 50% had kids.  They followed them at 7, 10, 15, and 20  years. They found the risk of the “metabolic syndrome” was reduced in women who breastfed.  This risk was reduced further the longer you breastfed.  For those who breastfed over 9 months, the risk went down 56% in those with no gestational diabetes (diabetes while pregnant, a marker for those at risk for diabetes later in life) and 86% for those with gestational diabetes.


They don’t know why. ? Does it increase your good HDL cholesterol?  Lower the abdominal body fat? Or help with the metabolism of blood sugar and lower your insulin levels?  We don’t know. But it was nice to see these results.

So let’s hear it for the girls.

Don’t worry- if they look bad when you are done, I can help you. But a healthy heart- that looks good on everyone.