Reply: Cohort Study to Assess the Impact of Breast Implants on Breastfeeding

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I truly appreciate the author’s insightful comments and valuable contribution. In Argentina, sanatoriums are private-driven institutions. Patients that enjoy a relatively high socioeconomic status opt for these clinics. The patients that choose these clinics are a homogeneous group in terms of education and income—they have all completed their basic formal education and have already received access to medical coverage. It is quite unlikely that these patients can be found to be illiterate. State hospitals are in charge of receiving those patients that lack medical coverage mostly because they are unemployed (they have also failed to finish a basic educational level). The cohort of women presented in this study belong to a social class that enables them to have access to both education and plastic surgery. It is also worth mentioning that those specific traits related to lactation training are part of prechildbirth courses held at the Sanatorio de la Mujer. During the patient’s hospitalization and for 1 week after the patient has been discharged, it is specialized lactation nurses who are in charge of guiding, teaching, and supervising their patients and their babies to achieve successful lactation.
As regards the telephone call as a means of collecting data 1 month after the baby’s delivery, it has proved to be a quite specific and reliable method to certify lactation. The World Health Organization defines breastfeeding where the infant receives breast milk (including milk expressed or from a wet nurse) and allows newly born babies to receive any food or liquid, including nonhuman milk and infant preparation (artificial baby milk) in which the milk volume is enough to ensure the newborn’s development. The World Health Organization’s definition of breastfeeding doesn't make any distinction between quality and quantity of milk. Thus, we believed it important to assess the establishment of lactation as a variable to analyze, regardless of the volume issue. What should matter the most is not the quantity of milk the mother produces but the weight the baby gains because of breastfeeding. In addition, when gathering the information for our study, we took into account not only the choice of approach but also the space for implant placement and implant type and size. Although the approach was clinically proven, the implant size, type, and placement were subject to how much the patients were able to remember all this information because they had been operated on by different plastic surgeons. This explains why it was not possible to register accurately—at least not wholly—these data. If we had taken these data in an incomplete way, that would have weakened the accurate comparison the study was meant to undertake.
My colleagues and I are convinced that, with this important study,1 we have managed to answer the very first query about the real chance of establishing breastfeeding with implants. From now on, new and numerous questions will keep arising. We are of the opinion that these questions need to be evaluated not only by plastic surgeons but also by specializations devoted to the newborn baby’s health.

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