title: The impact of cosmetic breast implants on breastfeeding: a systematic review and meta-analysis.
abstract: BACKGROUND
  Cosmetic breast augmentation (breast implants) is one of the most common plastic surgery procedures worldwide and uptake in high income countries has increased in the last two decades. Women need information about all associated outcomes in order to make an informed decision regarding whether to undergo cosmetic breast surgery. We conducted a systematic review to assess breastfeeding outcomes among women with breast implants compared to women without.
  
  
  METHODS
  A systematic literature search of Medline, Pubmed, CINAHL and Embase databases was conducted using the earliest inclusive dates through December 2013. Eligible studies included comparative studies that reported breastfeeding outcomes (any breastfeeding, and among women who breastfed, exclusive breastfeeding) for women with and without breast implants. Pairs of reviewers extracted descriptive data, study quality, and outcomes. Rate ratios (RR) and 95% confidence intervals (CI) were pooled across studies using the random-effects model. The Newcastle-Ottawa scale (NOS) was used to critically appraise study quality, and the National Health and Medical Research Council Level of Evidence Scale to rank the level of the evidence. This systematic review has been registered with the international prospective register of systematic reviews (PROSPERO): CRD42014009074.
  
  
  RESULTS
  Three small, observational studies met the inclusion criteria. The quality of the studies was fair (NOS 4-6) and the level of evidence was low (III-2 - III-3). There was no significant difference in attempted breastfeeding (one study, RR 0.94, 95% CI 0.76, 1.17). However, among women who breastfed, all three studies reported a reduced likelihood of exclusive breastfeeding amongst women with breast implants with a pooled rate ratio of 0.60 (95% CI 0.40, 0.90).
  
  
  CONCLUSIONS
  This systematic review and meta-analysis suggests that women with breast implants who breastfeed were less likely to exclusively feed their infants with breast milk compared to women without breast implants.
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Michal
authors.initials: M
authors.lastname: Schiff
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Algert
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Ampt
authors.affiliation: University of Sydney Endocrine Surgery Unit, Sydney, New South Wales, Australia ; Department of Endocrine and Oncology Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Sywak
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Roberts
keywords: Breast implants; Breastfeeding; Mammoplasty; Meta-analysis; Systematic reviews