Saturday, December 08, 2007

The "Squidworth's Nose" deformity : Does breast feeding make your breasts sag?

A study was presented at our major Plastic Surgery meeting in Baltimore which came to the conclusion that breast-feeding did not cause ptosis (drooping) of the breasts.

While I haven't seen the published manuscript yet, I find this conclusion somewhat implausible clinically and flawed based on the thumbnail descriptions of the methods of study used.

The researchers interviewed 132 women who consulted for a breast lift or breast augmentation. The women were, on average, 39 years old; 93 percent had had at least one pregnancy, and most of the mothers--58 percent-- had breastfed at least one child. Also evaluated were the patients' medical history, body mass index, pre-pregnancy bra cup size, and smoking status.

The results suggested no difference in the degree of breast ptosis (the medical term for sagging of the breast) for those women who breastfed and those who didn't. However, researchers found that several other factors did affect breast sagging, including age, the number of pregnancies, and whether the patient smoked.

Quantifying something as subjective as this is hard to do under most circumstances (and I give the doctor's credit for writing something interesting), but unless you study these women prospectively (rather then retrospective as was done here) and get better characterization of their baseline breasts size/shape, skin quality, body weight, and breast tissue tone (ie. firm vs fatty) then you really can make no valid conclusions about their hypothesis.

You get breasts that hang for a number of reasons including:

  • gravity (no explanation needed!)

  • thinning of the skin with age

  • attenuation of the internal soft tissue support of breast tissue (aka Cooper's Ligaments)

  • "tissue expansion" phenomena from weight gain or engorgement during lactation

Now in re. to ptosis and lactation, the tissue expansion effect is what I'd say predominates. Now as a lactating breast will be swollen for a longer time, it's pretty intuitive and obvious that it's going to affect the breast shape more. I'm skeptical from this intuitive POV plus an (occupational) observational basis on this idea that there's no difference after breast feeding.

One of the more common sub-groups in the breast augmentation or breast lift group are women in their early or mid 30's who present with "involutional ptosis" (our fancy words for saggy breasts after pregnancy). During my residency at the University of Louisville (KY), I can remember spending time with one of my favorite surgeons, Dr. Marc Salzman, who was kind enough to let me accompany him during his cosmetic surgery consults. There was a pretty girl ~ 33 years old who came in, and when describing what she did not like about her breast declared, "Dr. Salzman, after having my babies, my breasts now look like Squidworth's nose!". He was kind of puzzled by her comment, but I burst out laughing aware (due to having small children) that Squidworth is Sponge Bob Squarepant's boss on the popular cartoon show.

Pictured below is Squidworth. And you know what? Her breast looked exactly like Squidworth's nose. :)



ANA said...

Eh. How much does it really matter? The health benefits are great. You reduce your breast cancer risk and provide great health benefits to your child.

It's difficult and quite taxing. I hope there aren't women making the decision to breast feed or not based on the possibility of future drooping.

Anonymous said...

All I gotta say is that after three kids in three did make a difference. I don't need a study to tell me so. Thank you for the blog. I enjoy reading your perspectives and information.

Dr. Rob Oliver said...

I'm convinced the age you get pregnant has alot to do with this. Women who get pregnant in their early to mid 30's seem to be MUCH more prone to stretch marks and exagerated ptosis. The tone or tension of breast tissue really doesn't recoil well after it's expanded by prolonged lactation (or even merely just pregnancy in general).

This same phenomena is true with the abdominal wall as well. Women who deliver in their late teens or early 20's are much less likely to end up with "mommy tummy" from attenuated skin and lack of recoil of the abdominal wall muscles

Julie said...

I just turned 25 and have two children whom I breastfeed ( first born eight months, second born thirteen months)....I am really upset with how my breasts have changed postpartum....sigh. I want to have more children and would breastfeed again...but man part of me wants to have something done to look like I did before. My husband says just be glad you don't have cancer...I don't mean to be vain, but it is definitely a self-confidence issue. I didn't expect the sagging...I guess I always thought that happened to older women with larger breasts to begin with....

Julie said...

I am also still fighting 'mommy tummy' even though I had my children early too- 22 and 24 years old- I think part of it might be that the first was a c-section? and they were close together... Some say because I only recently weaned the body might be storing fat or something. I've been able to lose the postpartum just seems no matter how many core classes I take...I still look kind of like I'm in early pregnancy.... some women don't have this problem though...I guess I'm "lucky" that way. :P

Keri said...

Actually its "Squidward". And its spongebobs neighbor/coworker. Mr. Crabs is their boss. Mine are sagging and im not done breastfeeding..... Im 25. Had my first 6 months ago. I hope they at least come back up to hip level when they're done dragging the floor. :)