Abstract
BackgroundCosmetic breast augmentation (breast implants) is one of the most common plastic surgery procedures worldwide and uptake in high income countries has increased in the last two decades. Women need information about all associated outcomes in order to make an informed decision regarding whether to undergo cosmetic breast surgery. We conducted a systematic review to assess breastfeeding outcomes among women with breast implants compared to women without.MethodsA systematic literature search of Medline, Pubmed, CINAHL and Embase databases was conducted using the earliest inclusive dates through December 2013. Eligible studies included comparative studies that reported breastfeeding outcomes (any breastfeeding, and among women who breastfed, exclusive breastfeeding) for women with and without breast implants. Pairs of reviewers extracted descriptive data, study quality, and outcomes. Rate ratios (RR) and 95% confidence intervals (CI) were pooled across studies using the random-effects model. The Newcastle-Ottawa scale (NOS) was used to critically appraise study quality, and the National Health and Medical Research Council Level of Evidence Scale to rank the level of the evidence. This systematic review has been registered with the international prospective register of systematic reviews (PROSPERO): CRD42014009074.ResultsThree small, observational studies met the inclusion criteria. The quality of the studies was fair (NOS 4-6) and the level of evidence was low (III-2 - III-3). There was no significant difference in attempted breastfeeding (one study, RR 0.94, 95% CI 0.76, 1.17). However, among women who breastfed, all three studies reported a reduced likelihood of exclusive breastfeeding amongst women with breast implants with a pooled rate ratio of 0.60 (95% CI 0.40, 0.90).ConclusionsThis systematic review and meta-analysis suggests that women with breast implants who breastfeed were less likely to exclusively feed their infants with breast milk compared to women without breast implants.
Highlights
Cosmetic breast augmentation is one of the most common plastic surgery procedures worldwide and uptake in high income countries has increased in the last two decades
Of 946 unique records, 941 were excluded based on the title and/or abstract as they were irrelevant to the review, did not include the exposure or outcomes of interest, or failed to meet the other stated criteria (Figure 1)
The studies included in this review did not add to our knowledge of the specific mechanisms by which breast augmentation may disrupt normal breastfeeding function, as there was no detailed information on the surgical history and prevalence of complications was not reported
Summary
Cosmetic breast augmentation (breast implants) is one of the most common plastic surgery procedures worldwide and uptake in high income countries has increased in the last two decades. Women need information about all associated outcomes in order to make an informed decision regarding whether to undergo cosmetic breast surgery. Since the introduction of silicone gel and saline breast implants for cosmetic enhancement of breast size in the early 1960’s, breast augmentation has become one of the most common plastic surgery procedures worldwide [1]. Since there is an element of choice, women need information about all associated risks, both short and long term, in order to make an informed decision regarding whether to undergo cosmetic breast surgery
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