Breast surgeries and maintaining a healthy body weight are both prevalent concerns. In the UK, between 2013 and 2023, 80,427 women underwent breast augmentation and 49,795 had breast reductions. Understanding how weight changes impact breasts after these procedures is crucial.
Types of Breast Surgeries
Before diving into the effects of weight changes, let's briefly review the different types of breast surgeries:
Breast Augmentation: This surgery increases breast size and improves shape, using either implants (silicone or saline) or fat transfer.
Breast Reduction (Mammoplasty): This procedure addresses discomfort, neck and back pain, and other issues associated with large breasts. It involves removing fatty and glandular tissues and repositioning the nipple to reduce breast size and improve comfort.
Breast Lift (Mastopexy): This surgery addresses sagging breasts, often caused by volume loss from drastic weight loss.
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How Weight Changes Affect Breast Density
Breasts are composed of fatty (adipose), glandular, and fibrous connective tissues. Weight fluctuations alter breast density, impacting the ratio of these tissues. Significant weight changes (10-15 pounds or more) can affect surgical results, influencing breast shape, volume, and the visibility of implants.
Weight Gain: During weight gain, the proportion of fatty tissues in the breasts increases. As the body accumulates fat, breast tissues expand, leading to an increase in breast size. The skin stretches, potentially impacting its elasticity and resulting in stretch marks.
After Augmentation: Immediately after breast augmentation, some weight gain is expected due to fluid build-up and retention. This is a common post-surgical response as the body heals and inflammation reduces. Insignificant weight gain isn't concerning and may resolve naturally with exercise and lifestyle changes. However, gaining 20 pounds or more may cause implants to appear smaller or disproportionate.
After Reduction: Excessive weight gain can increase the size of the remaining fatty tissues, potentially reversing the results of breast reduction surgery. While the procedure removes excess breast and fatty tissues, the remaining tissues can expand with weight gain, possibly returning the breasts to their previous size.
Weight Loss: Weight loss results in the loss of fat cells throughout the body, including the breasts.
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After Augmentation: A small drop in weight won't significantly impact augmentation results with implants. However, drastic weight loss can reduce fatty tissues around the implants. After fat transfer augmentation, significant weight loss may lead to excessive loss of fatty tissues from the breasts, causing them to shrink.
After Reduction: A drastic loss of fatty tissues may cause the breasts to further reduce in size and appear deflated, altering their shape and appearance. Weight loss is also likely to leave you with loose, sagging skin.
Pregnancy and Breast Surgery Outcomes
Pregnancy causes natural changes in breasts, including increased size and soreness, darker nipples and areola, more noticeable veins, and stretch marks. These changes can impact breast surgery outcomes.
After Augmentation: Pregnancy and subsequent weight gain may increase breast size and volume. If implants were placed under the breast tissue, they might shift due to increased glandular tissue size.
After Reduction: Breasts will grow during pregnancy and childbirth, leading to visible changes.
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The Role of Hormones
Hormones play a crucial role in maintaining a stable weight and influence breast size.
Oestrogen: Starting from puberty, oestrogen stimulates fatty tissues in the breasts to collect fats, causing enlargement. Breasts respond to hormone changes during menstrual cycles, hormone replacement therapy, and post-surgery. Oestrogen also triggers hunger signals, influences insulin sensitivity, and regulates body metabolism.
PCOS: Women with Poly-Cystic Ovary Syndrome (PCOS) often have higher oestrogen levels, leading to insulin resistance. Increased insulin resistance results in elevated glucose levels, which are stored in fatty tissues, causing weight gain.
Menopause: During menopause, estradiol (a form of oestrogen that regulates body weight and metabolism) decreases, often leading to weight gain.
Oophorectomy: An oophorectomy (surgical removal of ovaries) can cause oestrogen imbalance, contributing to weight gain.
Thyroid Hormone: Low thyroid hormone levels slow down metabolism, affecting the body's ability to convert food into energy.
Cortisol: Cortisol, the 'stress' hormone, increases glucose levels in the blood, leading to increased insulin production. Chronic stress can cause insulin resistance, making it difficult for the body to convert calories into energy.
Managing Weight After Breast Surgery
Maintaining a stable weight through lifestyle changes is crucial for preserving the results of breast surgery.
Start with Light Exercise: Light walks can aid recovery and improve mental health. Gradually increase pace and intensity after full recovery.
Create an Active Lifestyle: Regular exercise and physical activity, such as walking and strength training, are essential for managing weight and supporting overall health.
Choose Nutrient-Rich Foods: Opt for healthier food choices. Include antioxidant-rich foods to boost skin health, manage stretch marks, and improve skin elasticity. Balance lean proteins with healthy fats to maintain muscle mass.
Focus on Omega-Rich Foods: Foods rich in omega-3 fatty acids, such as avocados, fatty fish, nuts, and seeds, add good fats to your diet and help maintain calorie intake.
Watch Your Calories: Create a calorie deficit through calorie counting to reach your desired weight before or after surgery.
Hit the Gym: Weight-lifting and strength-training can reduce unwanted fat, improve body contours, and maintain curves. Avoid pushing too hard initially.
Bariatric Surgery and Breast Density
Bariatric surgery is an effective method for treating obesity and reducing the incidence of obesity-related breast cancer. However, its impact on breast density is debated. A systematic review and meta-analysis of seven studies, including 535 participants, examined changes in breast density after bariatric surgery.
The average body mass index decreased from 45.3 kg/m2 before surgery to 34.4 kg/m2 after surgery. The proportion of grade A breast density decreased by 3.83%, grade B increased by 6.05%, grade C decreased by 5.32%, and grade D increased by 300%. Overall, there was no significant change in breast density (OR=1.27, 95% confidence interval [0.74, 2.20], P=0.38).
However, breast density increased significantly after bariatric surgery depending on the method used to detect breast density. This discrepancy is due to the differences in breast density evaluation software and methods. Qualitative breast density (BI-RADS) relies on the radiologist’s grading based on the proportion of dense tissue areas, which is subjective. Quantitative breast density (Volpara) calculates density from total breast volume and fibroglandular tissue volume using a specific algorithm.
Factors such as age, BMI, diet, lifestyle, chronic inflammation, medications, and reproductive history also affect breast density. Mammography remains crucial for detecting changes in breast density and early breast cancer. Digital breast tomosynthesis (DBT) improves imaging from two-dimensional to three-dimensional, enhancing the identification and differentiation between dense and adipose tissue.
Mastoplasty with Submuscular Autoprosthesis
After massive weight loss, breast changes dramatically, leading to ptosis, flatness in the upper pole, and significant skin excess. Mastoplasty with submuscular autoprosthesis is a safe and effective technique to treat these breast deformities.
This technique involves creating an inferior pedicle flap placed under the pectoralis muscle and a superomedial pedicle flap containing the nipple-areola complex (NAC). A study of 15 women who underwent this procedure showed that all patients were extremely satisfied with the breast volume, shape, symmetry, and ptosis correction. The new mammary contour and the distance between the jugular fossa and the nipple remained stable during the follow-up, and the upper pole maintained its fullness.