Impact of Breast Augmentation, Reduction, and Nipple Repair on Breastfeeding Success: A Systematic Review and Meta-analysis

Abstract Plastic surgery on the breast is among the most common aesthetic and reconstructive procedures performed today, with a variety of surgical approaches available. Emerging evidence suggests that these procedures may negatively affect breastfeeding. This meta-analysis aimed to assess the effects of breast augmentation, reduction, and nipple repair operations on breastfeeding success. A systematic literature search was conducted in Medline (via PubMed), Embase, and the Cochrane Library (CENTRAL). Prospective and retrospective studies were included with the endpoint of quantitative breastfeeding success rates. Using random-effects meta-analysis, we calculated pooled proportions with 95% confidence intervals (CIs) and compared subgroups where p<0.05 corresponded with a significant difference. 57 studies with 381,199 patients were used for the meta-analysis. No single technique for breast augmentation was associated with a significant difference in overall breastfeeding success (73.4% vs 86%, p=0.405). In contrast, comparing breast reduction techniques showed that some yielded significantly reduced breastfeeding success (p=0.021), particularly with classic reduction mastopexy surgical approach using horizontal (Prop=14.4%, CI 0–96%) and vertical (Prop=26.2%, CI 2–88%) pedicles. Other reduction approaches, including central (Prop=100%, CI 0–100%), superior-lateral (Prop=88%, CI 70–98%), superomedial (Prop=100%, CI 81–100%), and central-superior-lateral (Prop=100%, CI 86–100%) pedicles, showed promising breastfeeding outcomes. Nipple correction methods did not substantially reduce breastfeeding success (Prop=84%, CI 76–89%). Based on our results, nipple repair methods or breast augmentation do not appear to adversely impact breastfeeding outcomes, while breast reduction procedures are associated with a significant reduction in success, with variations depending on the surgical technique employed.