Breastfeeding is a cornerstone of infant nutrition and maternal health, delivering substantial physiological and psychological benefits. It provides essential nutrients and antibodies that promote cognitive development and protect against infections, obesity, and type 2 diabetes in infants (1–3). For mothers, breastfeeding is associated with a reduced risk of breast and ovarian cancers, cardiovascular disease, and type 2 diabetes, while also enhancing maternal-infant bonding (1, 2). Effective breastfeeding depends on various anatomical and physiological factors, including the integrity of breast structures responsible for milk production and transfer. Elective breast surgeries such as augmentation may alter these structures, potentially interfering with lactation (4, 5).

Silicone breast implants, favored for their natural appearance and feel, are used in over 80% of augmentation procedures in the United States (6–9). The American Society of Plastic Surgeons reported over 298,000 breast augmentation procedures in 2022, marking a continued upward trend in cosmetic surgery demand despite pandemic-related declines (10). In Saudi Arabia, shifting beauty norms and broader societal acceptance have similarly fueled a rise in cosmetic breast procedures. A national study by Alghamdi et al. (11) found that breast augmentation accounted for 31.2% of all plastic surgeries among adults in the country. Additionally, Mortada et al. (12) found that many Saudi women have limited knowledge about complications following breast implant surgery, suggesting a gap in informed decision-making.

While breast implants are generally considered safe, concerns persist regarding their impact on lactation. Surgical trauma may disrupt nerve pathways or damage milk ducts, leading to pain, latching difficulties, reduced milk supply, or early cessation of breastfeeding (13, 14). Systematic reviews have shown that women with implants have a significantly lower likelihood of exclusively breastfeeding and report higher rates of complications such as mastitis and lactation failure (15, 16). A prospective cohort study further confirmed that although many women with implants initiate breastfeeding, exclusivity rates remain significantly lower compared to women without implants (17).

Despite the increasing number of implant procedures in Saudi Arabia, region-specific studies on lactation outcomes remain scarce. Given that breastfeeding is deeply embedded in the country's cultural and religious values, this lack of data presents a critical gap in patient-centered care (18). Without access to accurate, localized information, women may struggle to make fully informed decisions about cosmetic breast surgery and its implications for future breastfeeding.

To address this gap, the present study describes breastfeeding practices and challenges among women in Saudi Arabia who have undergone breast implant surgery. Specifically, it explores breastfeeding initiation, duration, feeding method, and self-reported challenges. By examining the lived experiences of this under-researched population, the study aims to support evidence-based counseling and postpartum care tailored to the needs of women with breast implants.

The sample included 240 women aged between 23 and 33 years, with a mean age of 28.5 ± 4.11 years. Educational attainment varied: 28.3% reported no formal education, 24.2% completed high school, and 24.2% held a bachelor's degree. Regarding marital status, 39.2% were married, 32.1% divorced, and 28.8% widowed. A majority (60.4%) were employed, and participants reported between one and five children, with an average of 3.18 ± 1.41.

In terms of breast implant background, 35.4% of participants underwent cosmetic surgery, 25.0% for medical reasons, and 39.6% for reconstructive purposes. Implant type was reported as silicone by 40.4%, saline by 33.8%, and unknown by 25.8% (Table 1).

Prior to surgery, 42.5% intended to breastfeed. Postpartum, 50.4% initiated breastfeeding immediately, while the remaining 49.6% experienced delays. Breastfeeding duration varied: 36.7% breastfed for less than one month, 35.8% for 1–6 months, and 27.5% for more than 6 months. Exclusive breastfeeding was reported by 46.3%, while 53.8% practiced mixed feeding.

Reported breastfeeding challenges included pain during feeding (55.0%), perceived insufficient milk supply (48.3%), and breast or nipple issues (48.3%). Other concerns included milk production difficulties (33.3%), nipple sensitivity changes (4.2%), and the use of supplementary feeding (49.6%). A subset of participants reported latching difficulties attributed to altered breast shape (20.8%) and safety concerns about breastfeeding with implants (16.7%) (Table 2).

Bivariate analysis revealed statistically significant associations between breastfeeding duration and maternal age (p = .041), marital status (p = .027), and number of children (p = .026). In the multivariable analysis, only marital status remained a significant predictor of breastfeeding duration: married women had lower odds of breastfeeding beyond six months compared to divorced women (OR=0.38, 95% CI: 0.17–0.87, p = 0.022). No significant associations were observed between breastfeeding outcomes and education level or employment status (Table 3).

The research depicted a diverse demographic background of the participants. The average age was 28.5 years, which falls into the normal trend of studies involving breast implants that have patients in their mid−20s and early 30s (17, 22). The educational status distribution in this study showed that nearly a quarter of participants had no formal education, with the remaining participants having completed high school, bachelor's, or postgraduate degrees. In contrast, it was found that the majority of women undergoing breast implant surgeries in Saudi Arabia were well-educated, with most holding at least a bachelor's degree, while only a small fraction had no formal education (12). The reason for surgery in this study was cosmetic and reconstruction for three-quarters of the participants. In comparison, it was reported that 58.5% of women underwent breast implant surgery for reconstructive purposes and the remaining 41.5% for cosmetic reasons (12). This may suggest that demographic differences can influence the motivations for breast implants. In this study the most commonly used implants were the silicone ones, indicating an observed preference across many studies. This trend is likely attributed to the more natural feel and texture of silicone implants compared to saline alternatives (6, 17, 23).

In terms of lactation outcomes, 42.5% of participants reported planning to breastfeed prior to delivery, and 50.4% initiated breastfeeding immediately postpartum. Exclusive breastfeeding was reported by 46.3% of the sample, while mixed feeding was slightly more common at 53.8%. These findings are consistent with prior research suggesting that mixed feeding practices may be prevalent among women with a history of breast surgery, although differences across studies in design, population, and definitions of exclusivity warrant caution in direct comparisons (15, 21).

Broadly, breastfeeding among Saudi mothers showed variable trends. According to a national survey in 2023, the rate of exclusive breastfeeding at six months was 15% (25). In Taif, exclusive breastfeeding prevalence was 16.3% among infants aged 6–12 months (26), while a study in Tabuk found 31.4% of mothers exclusively breastfed to six months (27).

Pain during breastfeeding was reported by 55% of participants, while 48.3% cited perceived insufficient milk supply. These difficulties mirror challenges frequently documented in postpartum populations more broadly but have also been observed in previous studies involving women with breast implants. Some earlier reports have documented lower rates of breastfeeding pain than seen in this study (22). Additionally, nearly half of participants (49.6%) reported using supplementary feeding, further underscoring the complexity of breastfeeding experiences in this group and the potential influence of both physical and psychosocial factors.

Maternal age, marital status, and number of children were significantly associated with breastfeeding duration in the bivariate analysis. However, logistic regression model revealed only marital status statistically significant. Married women had 62% lower odds of breastfeeding beyond six months compared to divorced women (OR = 0.38, 95% CI: 0.17–0.87, p = 0.022). This finding contrasts with prior research (28, 29) where partner support was associated with longer breastfeeding duration. Possible explanation is that divorced women in this sample may have possessed more flexible daily schedules, which could facilitate sustained breastfeeding.

The number of children was also significantly associated with breastfeeding duration, suggesting that maternal experience may play a key role in sustaining breastfeeding. In this study, multiparous women reported longer breastfeeding durations compared to first-time mothers, consistent with prior research indicating that prior experience can enhance maternal confidence and persistence (30). However, no significant associations were found between number of children and breastfeeding intention or feeding method. This pattern implies that while previous parenting experience may not strongly shape prenatal decisions about breastfeeding, it may contribute to greater resilience and ability to continue breastfeeding despite potential challenges.

No significant associations were observed between educational level and any breastfeeding outcomes in this study. While this may appear inconsistent with international findings that often link higher education to improved breastfeeding practices, it aligns with research specific to the Saudi Arabian context. In this setting, women with lower levels of formal education may be more likely to adhere to traditional cultural norms and familial expectations that strongly favor breastfeeding, potentially offsetting the influence of formal education on breastfeeding behaviors (31).

This study addresses a gap in regional research by examining patterns of breastfeeding among women with breast implants in Saudi Arabia. By gathering detailed data on breastfeeding initiation, duration, methods, and self-reported challenges, the study provides considerable insights into the experiences of this group, potentially informing culturally sensitive clinical guidance and postpartum care practices. The use of a cross-sectional design enabled efficient data collection from a relatively large sample, supporting broad descriptive analysis within the target demographic.

However, limitations of the study include the use of convenience sampling, which may introduce selection bias as well as the inability to establish causation due to the cross-sectional nature of the study. Additionally, self-reported data may be subject to recall bias. Another limitation is the absence of a control group consisting of women who have not undergone any breast surgery.

To support informed decision-making among women considering breast implant surgery, healthcare providers should incorporate preoperative counseling that addresses potential implications for breastfeeding. Clear, evidence-based discussions about lactation outcomes can help align patient expectations with surgical decisions. Postpartum care should also be tailored to the needs of women with breast implants, offering targeted lactation support that addresses common challenges such as latching difficulties and concerns about milk production. Developing culturally sensitive breastfeeding education programs that specifically account for anatomical changes and patient concerns related to implants may further enhance breastfeeding success. Future research is needed to examine the long-term effects of breast implants on lactation, particularly within the sociocultural context of Saudi Arabia, where traditional values and family structures may influence breastfeeding behaviors and health-seeking decisions.

This study highlights that breastfeeding is feasible for many women in Saudi Arabia with breast implants, although various challenges are frequently reported. Approximately half of the participants initiated breastfeeding postpartum, but continuation beyond six months was less common, and mixed feeding was more prevalent than exclusive breastfeeding. In adjusted analysis, marital status was the only demographic factor significantly associated with breastfeeding duration. Commonly cited concerns included pain, perceived insufficient milk supply, and breast or nipple discomfort, while issues such as altered nipple sensitivity, latching difficulties related to breast shape, and safety concerns about breastfeeding with implants were reported less frequently.