Cohort Study to Assess the Impact of Breast Implants on Breastfeeding

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I read with interest the article by Filiciani et al. entitled “Cohort Study to Assess the Impact of Breast Implants on Breastfeeding.”1 The authors presented a prospective cohort study with 200 patients investigating the impact of breast implants on breastfeeding. We appreciate the work performed by the authors and we wish to discuss some limitations of the study.
First, the study involved 200 patients divided into two observational groups and the control group, chosen for similar anthropomorphic characteristics. The main variable was presence or absence of an implant; however, as far as we are concerned, many factors could affect mothers’ willingness to breastfeed after delivery, including social, economic, educational, and cultural factors. These confounding factors could cause bias in the study but were not taken into account.
Second, it would have been more convincing if the study had recorded more detailed information about lactation, such as the volume of breast milk of each patient, the proportion of breastfeeding and artificial lactation if the patient was using mixed lactation, the duration of breastfeeding or artificial lactation, and the quality of breast milk if possible. With these data, analysis of the breast implant’s impact on the quality of breastfeeding rather than the establishment of breastfeeding is achievable. Apart from the ability to breastfeed, the quality of breastfeeding is what most patients are concerned about. Unfortunately, this study’s outcome measure only included whether or not the patient had established breastfeeding. Furthermore, the lactation data were collected by phone calls, which we think could cause data loss and inaccuracy.
Third, the study analyzed the impact of different surgical approaches on breastfeeding, but did not provide information about the impact of different implant placement plane or different implant volume on breastfeeding. As breast plastic surgeons, we are very interested to know about such results. Thus, it is recommended that the impact of different implant placement planes or different implant volumes on breastfeeding be analyzed, because relevant data had been already collected in this study.
In conclusion, this study is a prospective research proving that breast implants do not affect the establishment of breastfeeding but it fails to answer the question about the quality of breastfeeding. There remain some questions to answer.

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