Milk discharge at a glance
- FrequencyRare (8 cases per 1,000 augmentations)
- OnsetAbout one month after the operation
- SignsSwollen, inflamed breast
- TestsProlactin and βHCG
- GalactoceleRevision surgery, washout
- TreatmentStopping milk secretion
After breast surgery, the gland occasionally starts producing milk again. This is called galactorrhoea when the milk flows out through the nipple, and galactocele when it collects inside the breast, around the implant or in small cysts. A galactocele shows itself about one month after the operation as a swollen, inflamed breast. It requires tests, medication to stop the milk secretion and, if fluid has collected around the implant, revision surgery to drain it and wash the implants.
Price: revision surgery on a written quote after consultation (€100).
Galactorrhoea and galactocele: what is the difference?
| Galactorrhoea | Galactocele | |
|---|---|---|
| What happens | Milk flows out through the nipple | Milk stays in the breast |
| Where | Outwards | Around the implant (if milk ducts have been opened) or in small cysts |
| Association | Often associated with a galactocele | Most often associated with galactorrhoea |
These complications can occur after breast augmentation as well as after breast reduction.
Normal breast: the milk ducts (2) connect the gland to the nipple; the implant (1) is in place. (default state).
- 1Implant
- 2Milk ducts (lactiferous ducts)
- 3Milk collected around the implant, and small cysts
Is it common?
No, these are rare complications. Caputy reports eight cases of galactorrhoea per 1,000 breast augmentations with implants. Only four cases of galactocele without galactorrhoea have been described in the literature; Dr Médard de Chardon’s thesis reports one.
Why does the breast produce milk?
The cause is still poorly understood. Several mechanisms have been put forward:
- a hormonal reflex: breast surgery may partly reproduce the suckling reflex, by stimulating the chest nerves involved in lactation, and raise the level of prolactin, the milk hormone;
- the stress of the operation: prolactin is also a stress hormone;
- the opening of milk ducts (lactiferous ducts): an incision around the areola, which crosses them, would explain milk collecting around the implant.
The position of the implant (in front of or behind the muscle) and its type do not appear to play a role.
What are the signs?
A galactocele shows itself as a swollen, inflamed breast, about one month after the operation. Without any associated milk discharge, it can be mistaken for an infection or a seroma (a collection of fluid), which is why a prompt examination matters.
How is it managed?
- Look for contributing factors: certain medicines (phenothiazine-type neuroleptics, meprobamate, antidepressants, the combined oestrogen-progestogen pill), menstrual disorders, previous pregnancies, a pituitary tumour, kidney failure.
- Measure in the blood prolactin and βHCG (to rule out pregnancy).
- Stop the milk secretion with medication.
- In the case of a galactocele, operate again to drain the milk, take bacteriological samples, wash the implants and put them back in place, with a drain. Some authors propose simple needle aspiration: Dr Médard de Chardon does not recommend it.
- Antibiotic: a single dose of a 2nd-generation cephalosporin at the start of the revision operation appears to be sufficient. Breast milk contains bacteria in 97% of cases, but the samples taken in these situations come back sterile.
The revision operation takes place at Clinique Oxford in Cannes.
Choosing a qualified, experienced and reputable surgeon reduces these risks, and can even eliminate some of them.
Dr Médard de Chardon’s experience
- MD thesis on breast augmentation with implants (Nice Faculty of Medicine, 2008), which reports one case of galactocele without milk discharge: this page is drawn from it.
- More than 3,000 breast implants placed; practising in Cannes since 2011.
- Qualified plastic surgeon in plastic, reconstructive and aesthetic surgery, former Chef de Clinique (university hospital senior registrar), Nice Faculty of Medicine; member of SOFCEP (French Society of Aesthetic Plastic Surgery), SOFCPRE (French Society of Plastic, Reconstructive and Aesthetic Surgery) and ISAPS (International Society of Aesthetic Plastic Surgery).
Frequently asked questions about milk discharge
Is it normal to have milk after breast augmentation?
It is rare (about 8 cases per 1,000 augmentations). It means you should see your surgeon, who will arrange tests and prescribe treatment to stop the secretion.
What is the difference between galactorrhoea and galactocele?
In galactorrhoea, milk flows out through the nipple; in a galactocele, it collects in the breast, around the implant or in small cysts.
When does a galactocele appear after breast augmentation?
Usually about one month after the operation, as a swollen, inflamed breast.
Is further surgery needed for a galactocele after breast augmentation?
For a galactocele around the implant, yes: the milk is drained, and the implants are washed and put back in place. Galactorrhoea alone is treated with medication.
Do the breast implants need to be changed for a galactocele?
No, the same implants are washed and put back in place.
References
- Médard de Chardon V. MD thesis on breast augmentation. Nice Faculty of Medicine, 2008.
- Caputy GG, Flowers RS. Copious lactation following augmentation mammaplasty: an uncommon but not rare condition. Aesthetic Plast Surg 1994; 18: 393-397.
- Kolodny RC, Jacobs LS, Daughaday WH. Mammary stimulation causes prolactin secretion in non-lactating women. Nature 1972; 238: 284-286.
- Inguenault C, Capon-Degardin N, Martinot-Duquennoy V, et al. [Galactorrhea after mammary plastic surgery]. Ann Chir Plast Esthet 2005; 50: 171-175.
- Boer HR, Anido G, Macdonald N. Bacterial colonization of human milk. South Med J 1981; 74: 716-718.