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11 Effects on Pregnancy, Lactation, and Children
Pages 248-263

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From page 248...
... Mothers with breast implants might also have problems with breast feeding due to the effects of implant surgery, the implant itself, or fear of lactation insufficiency and transmission of complications to their infants. The committee has reviewed the effects of breast implants, especially silicone gel breast implants, during pregnancy and lactation.
From page 249...
... , to be transferred to breast milk, silicone must diffuse or be transported across a number of cell membranes. The evidence reviewed in Chapter 4 does not support diffusion or transport of silicone gel across membranes that presumably would exclude substances of high molecular weight.
From page 250...
... (1998) compared breast milk and blood silicon concentrations in 14 and 15 blood and milk samples, respectively, from women with silicone gel implants and 23 and
From page 251...
... There were no significant differences in blood or milk silicon concentrations between these two groups (Lugowski et al., 1998~. In yet another report from the same laboratory comparing 15 lactating women with silicone breast implants to 34 lactating control women, mean silicon concentrations in breast milk were 0.0555 + 0.035 and 0.0511 + 0.031 ,ug/ml, respectively, and in blood were 0.0793 + 0.087 and 0.10376 + 0.112 ,ug/ml, respectively.
From page 252...
... The committee concludes that there is convincing evidence that infants breast-fed by mothers with silicone gel breast implants receive no higher silicon intakes from breast milk than infants breast-fed by mothers without breast implants. Infants receiving cows' milk or commercial infant formula feedings are likely to have significantly higher silicon intakes than breastfed infants.
From page 253...
... In the epidemiological study of children of women with silicone breast implants in Denmark discussed below, there was incomplete information on breast feeding (Kjoller et al., 1998~. Three studies have focused on the effects of augmentation mammaplasty on lactation sufficiency.
From page 254...
... Women with breast implants have also been less likely to attempt breast feeding due to their fear of problems stemming from the implant (Crase, 1996~. Although the data on periareolar incisions and lactation are suggestive, the mechanism of increased lactation problems due to implants remains uncertain; Hurst (1996a)
From page 255...
... Breast Feeding in the United States: Prevalence and Advantages In the United States, the prevalence of breast feeding at one week postpartum was 52% for hospital-born infants in 1989, and only 18% still were receiving breast milk by 6 months of age (Riordan and Auerbach, 1993~. In general, breast feeding is more common among older Caucasian women of higher socioeconomic status.
From page 256...
... The evidence for the advantages of breast feeding to infant and mother is conclusive. EFFECTS ON CHILDREN In the early l990s, claims were made that children of women with silicone breast implants might be adversely affected by transmammary or transplacental delivery of silicone during breast feeding or pregnancy (Gedalia et al., 1995; Levine and Ilowite, 1994; Teuber and Gershwin, 1994~.
From page 257...
... from a control group of 20 patients with feeding problems reduced to 17 by excluding 3 patients with achalasia. Six of the eight breast-fed children from mothers with silicone breast implants were reported to have significantly abnormal esophageal motility with nearly absent peristalsis in the distal two-thirds and decreased lower sphincter pressure based on esophageal manometry and upper-intestinal endoscopy with esophageal biopsy.
From page 258...
... No assays for silicon or silicone were performed, however, in any of the mothers or the children. As noted earlier in this chapter, silicon concentrations in breast milk of mothers with implants are not elevated above concentrations in lactating control women without implants.
From page 259...
... In this study, silicone did not accumulate in the esophagus, and no esophageal pathology was seen (Rave et al., 1997~. Since esophageal problems or decreased esophageal motility have not been found in bottle-fed children of women with silicone breast implants, any consequences for esophageal function appear to be related to
From page 260...
... Also, in the absence of any finding of elevated silicon or silicone in breast milk of mothers with implants or accumulating in the esophagus or elsewhere in the bodies of these children or in the esophagus of an experimental rat model, the committee has not found evidence that silicone could produce esophageal changes years after birth. No biologically plausible mechanism for an immune or silicone effect in breast milk associated with esophageal changes is apparent to the committee or has been suggested by others.
From page 261...
... (1996a) have reported studies of children born to women with silicone breast implants.
From page 262...
... Adverse outcomes included most esophageal disorders, defined connective tissue disease, other rheumatic conditions, and congenital malformations. Findings among the 939 children of mothers with breast implants included higher numbers of esophageal disorders, but the excess was similar for children born before and after implantation.
From page 263...
... No biologically plausible causation has been suggested. Convincing evidence is available that silicon concentrations in breast milk are the same in mothers with and without breast implants, and thus there are no data to support transmission of silicone to infants in breast milk of mothers with implants.


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