Pregnancy After Breast Augmentation: What Happens to Your Result

Pregnancy is the single biggest variable affecting the long-term result of a breast augmentation, and it is worth understanding before you decide when to have surgery.

What actually happens

During pregnancy and lactation the breast gland enlarges substantially, sometimes by several cup sizes. After breastfeeding stops, the gland involutes and volume falls away, often below the pre-pregnancy baseline.

It is the speed of that cycle that matters. A rapid increase followed by a rapid decrease stretches the skin envelope and the internal ligamentous support of the breast beyond what it can fully recoil from. The same thing happens with significant weight gain and loss.

The implant itself does not change. What changes is the tissue around it.

What you may notice afterwards

• Loss of upper pole fullness. The breast looks emptier at the top, with volume sitting lower.

• A change in the relationship between the breast and the implant. The tissue descends while the implant stays in its pocket, which can create a stepped appearance.

• Increased droop. The nipple sits lower relative to the crease beneath the breast.

• Asymmetry. Breasts frequently respond differently to pregnancy, particularly if feeding was uneven between sides.

Why some women need a lift

An implant adds volume. It does not lift tissue or tighten skin. If pregnancy has left a significantly stretched skin envelope with the nipple sitting low, adding or replacing volume alone will not correct the shape. A mastopexy, or breast lift, removes excess skin and repositions the nipple.

This is not a complication or a sign that anything went wrong. It is a normal consequence of the tissue changing after the original operation.

Does the technique make a difference?

Preservé preserves Cooper's ligaments and the internal ligamentous support of the breast rather than dividing them, because the pocket is created by balloon displacement rather than by cutting through tissue. Preserving that internal support is logically favourable for long-term shape. I would be cautious about claiming it prevents pregnancy-related change, because the forces involved are considerable.

Planning around it

If you are planning children in the near future, that is worth discussing openly at consultation. It affects implant size selection in particular, since a larger implant places greater demand on a skin envelope that pregnancy will stretch further. See choosing your implant size.

If you have already had children, waiting until breastfeeding has finished and volume has been stable for around six months gives the most reliable planning. Related reading: breastfeeding after breast augmentation.

Risks

Breast augmentation is surgery and carries risks including bleeding, infection, capsular contracture, altered nipple sensation, implant rupture, asymmetry and the possibility of revision surgery. These are discussed in full at consultation as part of the consent process.

Mr Ali Arnaout, MBChB, PGDip, AFHEA, FRCS(Plast), MBA — Consultant Plastic, Oncoplastic and Cosmetic Surgeon. GMC 7274609. iQonic Aesthetics, 15 Harley Street, London, and Dublin.