Breast Implant Pain after Breast Reconstruction

Breast implant pain following reconstructive surgery is an unfortunate but relatively common experience among patients who have undergone a mastectomy. This discomfort may be due to one of a number of conditions. Post-mastectomy pain syndrome (PMPS) is reported to occur in 25–60% of patients following breast cancer-related surgery. ⁽¹⁾ This pain is related to neuropathy; the damage or dysfunction of nerves in the area following breast reconstruction. But this isn’t the only cause of breast pain. Infection, migration of implants, atypical immune response, and other physiological problems can also arise.

Many patients experience pain in and around the site of their implants that may extend to the axillary area and the armpit. In some cases, this may affect arm mobility, which can be both debilitating and frustrating. It is understandable to feel disappointment and distress if further issues arise following a mastectomy. Breast cancer is the most common cancer diagnosed in women worldwide, and the stress of cancer treatment alone is an arduous battle, let alone having implants that “just don’t feel right.” 

Dr. Michael A. Howard is a board-certified plastic surgeon and a leading figure in breast reconstruction. He has conducted countless DIEP flap procedures and is proud to be a pioneer in mastectomy recovery. He also aids patients with postoperative assessment, and, where necessary, conducts breast reconstruction revision surgery. If you are experiencing implant pain following breast reconstruction, please call to make an appointment at your nearest office in Lake Forest, Chicago, or Glenview, IL. Contact us at (224) 271-4250 or fill out a form to make an inquiry and find expert treatment and surgical mitigation of breast pain.

About Post-Mastectomy Pain

Studies estimate there are over 3.8 million survivors of breast cancer in the United States alone. ⁽²⁾ These patients may have undergone a lumpectomy, breast preserving surgery, lymph-node dissection, or full mastectomy. During a mastectomy, surgeons completely excise breast tissue from the body to treat or prevent breast cancer. As part of the patient education surrounding the procedure, providers may brief these patients about the possibility of pain in the area. For example, patients commonly experience discomfort following radiation therapy. However, there is a difference between intermittent, short-lived pain, and persistent pain. Perioperative pain immediately after mastectomy is to be expected. Therefore, managing it and finding ways to mitigate it is crucial for patient wellbeing and quality of life. But if the discomfort persists past the expected recovery period, what comes next?

Post-mastectomy pain is something of a catch-all label for multiple things that could be happening in the body. It is therefore important to thoroughly assess the root causes of breast pain following surgery to establish the most effective treatment course.

Post-Reconstruction Pain

Breast reconstruction patients can experience significant disruptions in their daily life and their general well-being due to pain. Post-mastectomy pain syndrome can occur due to nerve damage and has a range of treatment options including medication, topical creams, regional anesthesia, and surgical intervention.  ⁽¹⁾ 

Post-mastectomy pain syndrome is just one of many reasons why implants could cause pain. Following breast cancer treatment patients can also experience a loss of range of motion in the upper limbs, decreased strength, and decreased ability to perform daily activities.  Patients may experience aching, tingling, or a pulling sensation in the breasts, armpits, and skin. This pain can:

Causes of Implant Pain

Implant-based surgery is the most commonly performed method of breast reconstruction. ⁽³⁾ And following that surgery, there will be a period of swelling and discomfort. However, where a patient has been experiencing pain for longer than anticipated, and where that pain is interfering with their day-to-day life, they should seek a timely medical assessment from an expert. The following conditions can cause breast pain after breast reconstruction.

Capsular Contracture

Capsular contracture is a condition in which thickened scar tissue develops around a breast implant. The body recognizes the implant as a foreign body and creates a fibrous “capsule” around it. This can lead to:

Though overall percentages are low (around 10% overall incidence), capsular contracture is the most common complication after breast augmentation, and can also occur after breast reconstruction. ⁽³⁾

Infection

An infection can occur after any surgical procedure. In the case of breast reconstruction, complications can range from mild to severe. The most common infection-causing bacteria in breast reconstruction is Staphylococcus aureus. These infections can lead to potentially serious conditions such as cellulitis, and can also affect the development of biofilm; a damaging extracellular structure that can cause treatments to be less effective, and lead to a condition known as capsular contracture. ⁽⁴⁾

Implant Distortion & Displacement

Breast animation deformity, or “dynamic” distortion is where the breasts move or become irregularly shaped when you flex your pectoralis muscle. This occurs when the healing tissue sticks to the chest muscle. Implant displacement is a condition where the implants have settled in the wrong position on the chest wall. They can move to either side (away from the center), move unnaturally close together (toward the center), or even flip. Both conditions require intervention, and both may cause pain and discomfort.

Breast Implant Illness

In rarer cases, other, more serious conditions may be the source of pain. Breast Implant Illness (BII) is a loose term given to a long list of symptoms experienced by some women with implants. They vary from patient to patient but the most common include fatigue, chest pain, headaches, and chills. ⁽⁵⁾ 

Reconstruction Revision Surgery

Research indicates that breast reconstruction patients without complications frequently opt for more than one reconstruction surgery. On average, in order to achieve satisfactory aesthetic results, around 40% of patients chose elective revisions. ⁽⁶⁾ And, in some of those cases, getting better aesthetic results isn’t the only reason for further surgery,

Dr. Howard performs reconstruction revision surgery for patients dissatisfied with their implants, whether they have undergone mastectomy and reconstruction or not. Where a person has had breast cancer treatment, there must be a thorough examination of the root cause of the pain. If the primary reason for the pain can be addressed surgically, Dr. Howard will create a personalized treatment plan to fix it.

Personal Consultation

Dr. Howard conducts one-on-one consultation sessions with mastectomy patients to discuss their goals. He understands the need for continuing care of the utmost quality and realizes that many women’s journeys with breast cancer have been extremely difficult. Where pain has been identified as an ongoing problem, you will have the opportunity to tell him exactly where the pain is, how intense it is, and how frequently you experience it. In addition to performing a physical examination, and an assessment of the position of your implants, he will ask you questions about your post-mastectomy reconstructive surgery. After getting all of the relevant information, he will discuss treatment pathways for reconstruction revision.

Cost of Breast Revision Surgery in Lake Forest, IL

The cost of your treatment will be discussed at your personal consultation. Dr. Howard uses his wealth of knowledge of human anatomy and physiology to ensure you get the most effective revision reconstruction surgery for your needs. Discuss ways to mitigate your pain following implant-based breast reconstruction with Dr. Michael Howard. Book your consultation in Lake Forest, Chicago, or Glenview by calling (224) 271-4250, or by filling out our online inquiry form.

References

1. Tan PY, Anand SP, Chan DXH. Post-mastectomy pain syndrome: A timely review of its predisposing factors and current approaches to treatment. Proceedings of Singapore Healthcare. Published online April 19, 2021:201010582110064. https://journals.sagepub.com/doi/full/10.1177/20101058211006419 
2. Chang PJ, Asher A, Smith SR.Post-mastectomy pain syndrome: A timely review of its predisposing factors and current approaches to treatment – Pei Yu Tan, Singh Prit Anand, Diana Xin Hui Chan, 2021 A Targeted Approach to Post-Mastectomy Pain and Persistent Pain following Breast Cancer Treatment. Cancers. 2021;13(20):5191. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8534110/#:~:text=Persistent%20pain%20following%20treatment%20for,pain%2C%20and%20pectoralis%20minor%20syndrome. 
3. Headon H, Kasem A, Mokbel K. Capsular Contracture after Breast Augmentation: An Update for Clinical Practice. Archives of Plastic Surgery. 2015;42(5):532. https://www.thieme-connect.de/products/ejournals/html/10.5999/aps.2015.42.5.532 
4. Song DH, Ooi AS. Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions. Breast Cancer: Targets and Therapy. 2016;Volume 8:161-172. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8534110/#:~:text=Persistent%20pain%20following%20treatment%20for,pain%2C%20and%20pectoralis%20minor%20syndrome. 
5. Kaplan J, Rohrich R. Breast implant illness: a topic in review. Gland Surgery. 2021;10(1):430-443. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882356/#:~:text=Recently%2C%20the%20term%20breast%20implant,and%20chronic%20pain%20amongst%20others. 
6. (&) Stoeckl E, Dedhia PH, Wilke LG, Long KL. Necrotizing soft tissue infection of the breast: bilateral presentation in a male patient. Annals of Breast Surgery. 2019;3:19-19. doi:10.21037/abs.2019.08.04