It's only natural for moms-to-be to want to know if they'll have an easy time breastfeeding well in advance — and usually that's impossible to find out until they've got a baby in-hand. One factor that many wonder about, possibly even before conceiving, is whether previous breast surgeries or modifications will ruin their chances of being able to nurse.
The brief and encouraging, if totally unsatisfying, answer is probably not, but, of course, there's more to it than that.
According to Jeffrey A. Ascherman, MD, professor of surgery at Columbia University Medical Center, your ability to breastfeed actually depends on the type of augmentation you've undergone.
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Having breast implants, he says, shouldn't have any impact on whether you can nurse or not. Most breast enlargement procedures start with an incision at the bottom of the breasts or in the armpits, and then the implants themselves are placed beneath the breast tissue. In other words, breast enlargements very rarely affect the rest of the breasts, let alone the milk ducts. (And, for the record, breast implants won't affect the quality or composition of breast milk.)
Breast reductions, however, are a slightly different story. Dr. Aschmerman explains that, unlike a breast enlargement, a reduction involves the removal of breast tissue — which could include milk ducts. But that's not guaranteed: "Just like with sensation in breast reduction, you can’t predict it. Some people will have it afterward, some won’t. It's the same with breastfeeding."
Unless you undergo a complete mastectomy, in which the entire breast is removed, you will retain some of your milk ducts. It's possible you may end up producing less milk than average, after having a breast reduction, but there's no reason to believe the surgery will bar you from breastfeeding normally. Some people suffer low milk production who've never so much as glanced sideways at their breasts, so it's not like avoiding surgery means you'll be able to go full cow once your kid arrives.
On the nonsurgical side of things, there are nipple piercings. Some moms have reported additional leakage and difficulty latching, and it is important to watch out for infections and blocked ducts while nursing with an open piercing. (As well as the obvious choking hazard of a piece of jewelry, so make sure you remove rings and barbells before bringing baby to your breast.) But, as long as the hole is totally healed (which takes up to a year), your nipple piercing will not make you incapable of breastfeeding.
As we said before, the question of nursing after breast augmentation is best answered on an individual level. Talk to your doctor or schedule an appointment with a lactation consultant if you have concerns. And bear in mind: "It's like breastfeeding in general," Dr. Ascherman says. "Some women can do it, but not all."
August is Breastfeeding Awareness Month. For more coverage on nursing, pumping, or choosing not to do either, head over to our Mothership page.