- How do I know if my breast implants are in trouble?
- What is capsular contracture and how can it be treated?
- What is capsular contracture?
- What causes capsular contracture?
- How does Aspen treat and reverse capsular contracture?
- What Does Your Breast Implant Pain Mean?
- Incision Pain
- Capsular Contracture
- Enlarged Lymph Nodes
- Toxic Shock Syndrome
- Itching and Irritation
- Wound Dehiscence
- Breast Implant Pain after 5, 10 or 15 Years? Here’s What to Do
- What Causes Breast Implant Pain?
- Best Case Scenario: You’ve strained your muscles
- Worst Case Scenario: Your body is rejecting the implant (capsular contracture)
- Can a Ruptured Implant Cause Pain?
- When Do Implants Need to Be Replaced, Anyway?
- Recovery Restrictions and Milestones
- Managing Pain and Discomfort
- Breast Implant Settling
- Other Concerns You May Encounter
- Tips for a Quick Breast Augmentation Recovery
- Who is at risk of capsular contracture?
- Signs and symptoms of capsular contracture
- Corrective surgery options for capsular contracture
- Implant patients see problems 20 years later
- FDA: Breast implant problems grow with time
- Constance M. Chen, MD, FACS
- The truth about breast implant-related cancer risk
- What BIA-ALCL symptoms should you look for?
- How is BIA-ALCL diagnosed and treated?
- You have options after breast cancer surgery
How do I know if my breast implants are in trouble?
There are symptoms and signs that may indicate problems associated with breast implants. However, one must always remember that majority of implant ruptures are picked up incidentally on ultrasounds and mammograms. On the other hand, some of the symptoms and signs mentioned below may not be due to the breast implant, but rather possible disease within the breast tissue itself.
Breast pain, breast discomfort, nipple sensitivity and soreness are not uncommon presenting complaints from patients with breast implants. Many attribute it directly to the implants but one must remember, idiopathic (unknown medical cause) breast and nipple pain is actually a very common phenomenon in women in general. If the discomfort is not associated with hardening, shifting or changes in the implant shape, a simple ultrasound or MRI can provide reassurance that the implant is intact, and may also allow detection of any abnormal breast tissue overlying the implant.
Breast lumps are often a concerning feature in patients with or without breast implants. In patients with old liquid silicone implants, pockets of silicones which has seeped into the breast tissue can form hard lumps. These can be detected and differentiated from breast cancer lumps via imaging techniques such as ultrasound, mammogram and MRI.
Change in breast shape or progressive asymmetry between the two breasts. Breast implants can move on the chest wall, or capsular contracture can push an implant upwards. This often occurs slowly overtime, thus can be difficult for some to notice. However, if you find that your bra sits crooked because your breasts are not at the same level, or if it doesn’t fit because one is sitting a little further into the armpit, then it may be time to see your doctor or a plastic surgeon. Don’t forget, sometimes pre-existing natural breast asymmetry can become more obvious after weight changes or even hormonal fluctuations such as pregnancies or menopause. This means, you may need a change in the size of your implants to correct the difference between the two sides.
Breast swelling is very rarely associated with breast implants. This can be associated with trauma to the chest wall (you may have bled around the implant), or it may be spontaneously with no precipitating event. The former requires urgent surgery, the latter requires further investigations into the cause of the swelling. Swelling can be due to fluid around the implant or infection. Swelling can sometimes be associated with abnormality in the breast tissue and need to be thoroughly assessed.
Breast skin or nipple discharge need to be taken seriously. If there are any discharge from an open sore on the breast or the nipple, please see your doctor. This could be implant-related or associated with diseases of the breast tissue or nipple, which may not necessarily be cancer.
Please contact your doctor or seek a referral to an accredited plastic surgeon if your breasts exhibit any of the abovementioned symptoms.
Our next blog will discuss the management of ruptured implants.
To read more about breast implant surgery, please.
What is capsular contracture and how can it be treated?
Sometimes, no matter how skilled a patient’s plastic surgeon is, complications arise during or after surgery. This is the case because everyone’s body is different. The composition of connective tissue varies widely from one patient to another, for instance, and this means that each patient’s healing process is entirely unique. This is why some people tend to develop thick scar tissue after any kind of penetrating skin injury, while others can sustain deep cuts and develop only subtle scarring that fades over time. Another good example of this difference is the way some women will develop severe stretch marks during pregnancy no matter what they do to prevent them, whereas other women emerge from pregnancy nearly stretch mark-free. Additionally, everyone’s immune system responds differently to stimuli, and some patients’ immune systems react poorly to medical implants.
Of course, complications during plastic surgery are now very rare, both because of advances in surgical techniques and because we’ve gotten better at predicting which patients are likely to experience surgical complications. Patients who are prone to developing thick scar tissue may be advised to avoid having plastic surgery, or their surgeon will use special surgical techniques that allow incisions to be placed remotely (e.g., inserting breast implants through an incision in the underarm) in order to keep scarring largely out of sight. Patients who have compromised immune systems or autoimmune diseases are often advised to forego surgery and choose less invasive forms of cosmetic enhancement. Likewise, there are a number of procedures that can be used after surgery, such as the Aspen Rehabilitation Technique, in order to treat complications and improve the patient’s appearance. One of the most common areas where Aspen is used is in the treatment of capsular contracture after breast augmentation surgery.
What is capsular contracture?
The formation of a “capsule” of scar tissue around any kind of implant (medical or cosmetic) is a normal part of the healing process. The body automatically reacts to any foreign object it detects within it and attempts to isolate said object by creating a barrier of scar tissue around it. In the case of breast implants, this is usually a good thing – the capsule helps to keep the breast implants in place, preventing slippage. In some patients, however, this capsule of scar tissue becomes unusually hard and starts to contract around the implant. This can lead to both aesthetic problems and, in extreme cases, pain in the breasts. Research shows that about one in six breast augmentation patients experience some degree of capsular contracture, though not all cases present with obvious symptoms. The severity of capsular contracture is rated using a grading system:
- Grade 1: Grade one capsular contracture is asymptomatic (producing or showing no symptoms). The formation of scar tissue around the implant does not interfere with the size, shape or texture of the breasts. The breasts look natural and remain soft to the touch.
- Grade 2: Grade two capsular contracture usually presents itself with only minor cosmetic symptoms. The breasts will usually appear normal in shape but feel somewhat firm to the touch.
- Grade 3: Grade three capsular contracture presents itself with obvious cosmetic symptoms. The breasts will be firm to the touch and appear abnormal, e.g., they will be overly round, hard-looking and the nipples may be misshapen. However, this grade of capsular contraction often doesn’t cause much (if any) pain.
- Grade 4: Like grade three capsular contracture, grade four capsular contracture causes the breasts to become hard and misshapen. Patients with grade four capsular contracture also experience breast soreness; their breasts will often be tender and painful to the touch.
Generally, capsular contracture occurs during the healing process. About 75% of all capsular contractures will occur within two years of the patient’s implants being placed. Sometimes capsular contractures occur many years after breast augmentation surgery, but this is the exception rather than the rule. If this does occur, the patient’s breast implants should be checked for ruptures. Ruptured implants are the most common cause of late-onset capsular contraction.
What causes capsular contracture?
Clinicians have a number of theories on what causes capsular contracture, and it’s likely that the exact causes of this condition vary from patient to patient. As a breast augmentation patient, it’s important to understand that this condition is not caused by breast implants being in any way toxic or dangerous. Saline implants contain only saline solution, which can be safely reabsorbed by the body with no ill effects, and silicone gel implants are made of medically inert silicone. Indeed, capsular contracture can happen after any kind of medical implant is inserted into the body; the condition is not unique to breast augmentation surgery. Capsular contracture is just particularly troubling when it occurs after breast augmentation because it often alters the appearance of the breasts, thereby jeopardizing the aesthetic improvements that the patient had surgery to create. Capsular contracture is not usually dangerous to the patient’s health unless her implants have ruptured (in the case of gel implants, rupture can sometimes lead to infection).
Researchers believe genetics play a role in who develops capsular contraction and who does not. If you have a family history of autoimmune disease or you have relatives who frequently develop thick scar tissue after injury (or who have had difficulties with medical implants), then you may have a slightly heightened risk of developing this condition. However, it’s impossible to accurately predict who will develop a “random” case of capsular contracture (i.e., one that is not caused by any identifiable external factors) and who will not. Because capsular contracture is highly treatable, you shouldn’t let a fear of developing this condition hold you back from getting breast augmentation surgery.
Sometimes, capsular contracture is caused by something other than the patient’s own body reacting poorly to the presence of breast implants. In addition to implant ruptures, it is now believed that something called “biofilm” often leads to the development of this condition. Biofilm is a thin layer of bacteria that develops around implants after a type of bacteria (often staph bacteria) is introduced to the breast cavity during surgery. This bacterium causes a kind of chronic, low-grade infection that may not produce noticeable symptoms (such as fever or severe fatigue). However, as the body combats this infection, it produces more and more fibrous scar tissue, eventually leading to capsular contracture. The biofilm theory of capsular contracture was given credence by a recent study conducted on pigs who were implanted with medical-grade silicone implants. This study showed that there was a significant increase in the likelihood of capsular contracture in those pigs who had staph bacteria on their skin at the time of implant placement. It’s important to note that staph contamination during breast augmentation surgery does not necessarily result from an unhygienic working environment. Some people are natural carriers of staph bacteria; it’s always present on their skin and usually causes no symptoms. Only when these individuals have their skin penetrated does this bacterium have a chance to cause any serious issues. While ensuring a clean working environment can certainly help to lower the risk of staph contamination, it’s not always possible to eliminate 100% of the bacteria that are present.
Other rare complications of breast augmentation surgery, such as hematomas and seromas (blood clots that sometimes form after invasive surgery), are also believed to increase the risk of capsular contracture. Some researchers believe these blood clots increase the likelihood of capsular contracture by providing a rich supply of nutrients (in the form of blood) for bacteria, thereby encouraging the growth of biofilm. How can capsular contracture be prevented?
While it’s impossible to prevent capsular contracture from occurring in every patient, there are several ways to lower a patient’s risk of developing this condition. To that end, plastic surgeons now employ a number of different preventative strategies, as outlined below:
- Thorough patient screening: Patients are screened for health conditions that might increase their risk of complications like hematomas. Patients are also required to give up smoking, as smoking makes hematoma formation more likely and generally impairs the healing process.
- Using the correct size of implant for the patient: Placing a large implant in a patient with insufficient natural breast tissue to cover said implant increases the risk of capsular contracture. If a patient with small breasts wants to increase her cup size significantly, it’s better to do so in stages, e.g., start with a mid-sized implant and give the skin time to stretch before placing a larger one.
- Minimal implant handling: The more an implant is handled prior to being inserted into the patient’s breast, the more likely bacterial contamination becomes. As such, surgeons strictly limit how much they touch any implant before placing it in the patient’s body. Board-certified plastic surgeons also work in a sterile hospital facility.
- The use of textured gel implants: Using gel implants with a textured surface, rather than a smooth surface, has been shown to reduce the likelihood of capsular contraction. It is thought that the textured surface of the implant makes it more difficult for thick scar tissue to develop around the implant. However, textured implants are not right for every patient, as in some cases their edges may be more detectable. They are usually most suitable for use when the implants are being placed below the chest muscles.
- The use of “under the muscle” placement: Placing implants under the chest muscles can significantly lower the risk of capsular contracture. Partial under the muscle implant placement results in an 8-12% lifetime risk of capsular contracture, as opposed to a 12-18% lifetime risk of capsular contracture with over the muscle implant placement. Furthermore, implants that are placed completely under the muscle are associated with just a 4-8% lifetime risk of capsular contracture.
- Massage: Gently massaging the breasts while they heal from breast augmentation surgery may help to prevent capsular contracture by encouraging the breast tissue to remain pliable. However, this method has not been proven effective by any major studies. You should never disturb the tissue of your breasts while they are healing from surgery without first getting permission from your surgeon. Otherwise, you may damage the tissue and make capsular contracture more likely.
How does Aspen treat and reverse capsular contracture?
In the past, the treatment options available for breast augmentation patients with capsular contracture left much to be desired. Revision surgery was often required—a lengthy, costly and uncomfortable solution. During this process, the patient’s implants were removed, she was treated with antibiotics and eventually (once the infection had subsided), she could choose to have breast implants inserted again. However, because this surgical approach makes the body vulnerable to a second bacterial invasion, many of these patients experienced repeated incidences of capsular contracture.
Aspen multi-energy therapy is different. It’s completely noninvasive, so it doesn’t cause the patient pain or inconvenience, nor does it increase her risk of developing capsular contracture again in the future. During Aspen therapy, a special device (the Aspen harmonizer) is applied to the patient’s breast tissue, without any incisions being made. The Aspen harmonizer delivers precisely controlled ultrasound waves to the patient’s tissue, encouraging the growth of healthy collagen. This increases elasticity within the breast capsule around the implant, making the breasts feel soft and pliable again. Furthermore, the ultrasound waves used during Aspen therapy have been shown to increase the effectiveness of antibiotics in combating biofilm. Aspen therapy is usually administered over two to three weeks in combination with antibiotic therapy to target the root cause of capsular contracture. The Aspen method has been shown to be effective for grade two and grade three cases of capsular contracture. Grade four cases may require more aggressive surgical intervention.
If you’re a good candidate for Aspen therapy, this pain-free procedure can treat and reverse capsular contracture. Contact a board-certified plastic surgeon to learn more about this procedure.
The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.
What Does Your Breast Implant Pain Mean?
Often, patients will experience breast implant pain immediately following breast implant surgery. It is important to understand whether the pain that you experience is normal or if you are experiencing abnormal that your doctor needs to address. Although the following issues are the most common causes of breast implant pain, it is also important that you consult with your doctor if you experience pain outside of the normal scope of surgery. If your breast implant pain returns or if it has been years since your surgery and you suddenly experience breast implant pain, make an appointment with your doctor to find out the source of your pain and find a solution.
Your incision sites may be sore or painful after the procedure. While breast implant surgery is minimally invasive, the doctor still needs to make an incision to get the implant into your body. Over-the-counter painkillers can provide relief, but you may receive a prescription medication to help with your recovery. Visit your doctor if the breast implant pain is unusually severe, lasts more than a few weeks or if you see signs of infection.
Is your breast implant pain associated with an increased hardness in one or both of your breasts? Some people experience capsular contracture, which is a condition caused by the breast tissue tightening around an implant. This can happen at any point after your surgery. Let your surgeon know as soon as you experience any changes, so he can take the necessary steps to reduce your pain.
Tenderness, swelling and a bruise-like appearance of the area near your incision spot are classic hematoma symptoms. The blood from the incision site can pool and clot in nearby tissues, which creates a small lump. You need to get your doctor to check on any unusual lumps in your breasts following the surgery, as they may also indicate a more serious condition. Many hematomas go away without any treatment. If your doctor is concerned about the size, severity or longevity of the hematoma, he can either drain the blood or surgically remove it.
Enlarged Lymph Nodes
The lymph nodes in your armpits may swell or feel painful for several reasons. You could have an infection at the incision or within your breast tissue, which causes this reaction. A lymph node could get damaged during the breast implant procedure and grow in size due to a potential infection or while it heals. In either case, consulting with your surgeon is the best way to rule out any serious problems and get back on track with your recovery.
A body liquid called serum can gather near the incision. If it builds up too much, it creates a lump referred to as a seroma. When you touch the area, you may feel burning or general breast implant pain. Pay close attention to your healing wound when you suspect that liquid is collecting within the breast tissue — you should see clear serum leaking out of the incision. In most cases, the fluid takes a couple of weeks to gather. See your surgeon and have the seroma drained to eliminate this pain.
Burning sensations, pain or changes in breast appearance may be a sign that your implant ruptured. The painful feelings are most commonly associated with silicone implants, while sudden size changes are more prevalent with saline. You may have this problem immediately following your procedure or years down the road. Medical tests involving the breasts, such as mammograms, can create tears or holes in the outer material. In some cases, an implant is older and simply fails over time.
Toxic Shock Syndrome
A sudden fever, seizures and rashes are several symptoms associated with toxic shock syndrome. This serious complication is a bacterial infection that needs your doctor’s attention immediately, as it can be fatal without treatment. You may receive an antibiotic course to fight the bacteria, but surgery is a possibility. Most likely, you will need to stay in the hospital for ongoing monitoring and support until the infection clears up.
Tissue can die if it can’t get the oxygen it needs. During surgery, the blood supply for some areas may be altered or damaged. The skin goes through a spectrum of blue, purple and finally black, and the wound starts to reopen. Necrosis is a painful and serious breast implant complication. Going to your doctor as quickly as possible can limit both damage and health risks. Smoking greatly increases the chances of necrosis, as you already have less oxygen moving through your bloodstream. Your greatest risk of developing this condition is right after the procedure while the incision is healing.
Itching and Irritation
Your wound may feel irritated and itchy as it goes through the healing process. If you don’t see any signs of infection, such as swelling or pus, you don’t have anything to worry about from these sensations. However, don’t be afraid to talk to your doctor if you feel like the incision has an unusual amount of irritation.
An infected incision could speed up the rate at which dissolvable sutures break down. If they disappear before you’re fully healed, the two sides of the wound will pull apart from each other. This condition, called wound dehiscence, can also occur if you try to lift heavy things or do strenuous activity too soon after your surgery. You need to get to a doctor right away to treat this wound and avoid additional complications.
Breast implant pain can be an indication that something is wrong with your breast implants. If you experience breast implant pain, make an appointment with your breast implant expert to find a safe and effective solution.
Are you feeling pain after breast augmentation? Sydney based surgeon warn that the presence of breast implants can make breast tissue abnormalities harder to detect. However, there’s no need to be so worried as this is very rare and complication rates are low. Also, it’s common to experience pain and discomfort after undergoing the breast surgery.
However, some ladies specifically experience some nipple pain after breast augmentation. If you’re one such lady, find out the causes and possible ways to manage the pain.
Causes of nipple pain after breast augmentation
There are certain things about you as well as the surgery that impact the extent of pain you’ll observe. The size of the implants has a direct relationship with nipple pain. If the implants are larger, you’ll endure more pain after the procedure.
Positioning of implants also affect the level and magnitude of pain. Implants placed beneath the chest, pectoral, or muscles hurt more and pose high discomfort to your nipples. This is mainly because your breast tissue around nipples is enduring more trauma.
How to relieve the pain?
While mild pain is okay, severe pain can be really discomforting. It can keep you from participating in your daily chores. As such, you need to find ways to ease the pain.
Usually, surgeons prescribe generic pain relieving medicines to ease all sorts of pain after the procedure. However, if you experience more pain, you may seek specialized medications to heal the condition faster. After diagnosing the problem, your surgeon will prescribe suitable medications aimed at easing nipple pain.
Today, many healthcare companies offer a pain pump. It’s a device that offers numbing medication to the problem area around nipples for 2 to 3 days when the pain is severe.
Providing some sort of support to your breast will reduce nipple pain substantially. An elastic bandage or surgical bra could come in handy. Support your breast with these things to alleviate pain.
Nipple pain after breast augmentation can take a heavy toll on any woman. However, getting rid of the pain and discomfort is definitely possible. Stick to the above tips and you could ease your pain substantially.
Breast Implant Pain after 5, 10 or 15 Years? Here’s What to Do
- If you’re feeling pain in your breast area, you’ve most likely either strained your muscles or are experiencing capsular contracture
- Strained muscles are not a big deal; capsular contracture is and needs to be addressed immediately
- Breast implants do not have a ‘lifespan’, but after 10 years complications become more common
What Causes Breast Implant Pain?
There are two major reasons why breast implants can cause pain in the chest area years after the procedure:
Best Case Scenario: You’ve strained your muscles
While both silicone and saline breast implants are relatively light in terms of weight, after the breast augmentation procedure you’re effectively carrying additional weight on your chest. This can cause strain on some of your muscles in the chest area. More importantly, breast implants take up additional space in your chest area, which might cause practical musculoskeletal complications. If that’s the case, the pain will most likely be concentrated towards the nipple. There are several ways this can happen:
- Pectoral exercises in the gym. Putting physical stress on your chest muscles can cause natural muscle soreness, which is often misjudged as implant-induced pain. In some cases, the implant may have added to the pain through a strain of sensory nerves. Either way, an exercise-related soreness is not dangerous (unless taken to extremes), and you should continue to work out. The pain should fade away as your body adjusts to the exercise. We encourage our breast augmentation patients to actively exercise, including training your chest muscles.
What to do if you’re experiencing exercise-related pain:
1. Stretch your muscles before and after the workout
2. Warm up for at least 10 minutes before the workout
3. Don’t increase your workout intensity until the pain fades
4. Take a warm bath
5. Take a muscle relaxant
- Lots of coughing. One of the most common reasons for an unexpected breast implant pain years after the procedure is a cough-inducing illness. Coughing is actually one of the main reasons why smoking is prohibited weeks before and after breast augmentation. Here’s an explanation of how coughing causes chest pain for breast augmentation patients:
- Costochondritis is the inflammation of the joint of the ribs that connects the cartilage to the bone. Whenever we breathe (make our lungs to expand and collapse), there is a slight mechanical collision in the rib junction. When we’re ill and cough a lot, this movement occurs frequently. And, with breast implants in place, there’s even less space in the chest area, thus the mechanical friction becomes times more intense. This friction causes the inflammation, which, in turn, causes the pain.
What to do if you’re experiencing cough-related pain:
1. Focus on healing and reducing the cough
2. Consult your doctor on analgesic medication
3. Take anti-inflammatory medication
4. Try to stay put until the cough goes away (stay in bed or seated), any additional movement only adds onto the inflammation
5. Take a muscle relaxant
- New Type of Physical Activity. This is similar to the exercise-related breast implant pain. Any physical activity that your body is not used to might cause a strain of your chest muscles and irritation of your sensory nerves. Think of it this way: your body would react to the activity either way; the implant only raises the sensitivity of your nerves in the chest area slightly. The activities that could cause the pain include:
- Outdoor activities. Have you recently taken up hiking, mountain cycling or yoga? This might have put unexpected stress on your chest muscles, which causes the pain.
- Playing with your children/pets. Have you recently become a mother, or have gotten a puppy as a birthday present? Congratulations! However, all of that newfound physical activity can put an unexpected strain on your chest muscles.
- Hobbies and household chores. Household chores and newfound hobbies such as gardening can become a reason for your breast implant pain. These activities need not be extremely physically demanding; if they’re repetitive enough, they can cause irritation in your chest area.
What to do if you’re experiencing activity-related pain:
1. Identify any new, repetitive physical activity that you’ve taken up recently
2. Try to limit that particular activity for a while until the pain goes away
3. If you can’t do that, think about which parts of the activity could strain your chest muscles, and how could you avoid that movement
Bottom line: physical soreness in the chest area can occur due to physical activity and mechanical friction. The pain can be made worse if you have had a breast augmentation procedure. The pain is not dangerous, and the treatment should not change due to the implants.
Worst Case Scenario: Your body is rejecting the implant (capsular contracture)
If none of the above descriptions match your case, then the reason you’re having soreness could be your body’s natural protective reaction towards the foreign object (the implant), otherwise known as capsular contracture. Our bodies are intelligent: when a foreign object is put inside your body (like a breast implant), your immune system forms a protective layer of organic tissue around the foreign object to prevent it from moving, growing, or damage your body in any other way. During capsular contracture, the organic tissue around the implant (the “capsule”) shrinks (“contracts”), causing pain and discomfort. The contracture may also cause your implant to move and flip.
What Causes Capsular Contracture in Breast Implants?
The defensive reaction could be caused by several reasons:
- An infection. Usually, the infections that cause capsular contracture “sneak in” during the initial surgery. If the operating surgeon does not follow all necessary hygiene and safety procedures, this may be the cause of the contracture.
- A seroma. Seromas are pockets of fluid that form within your body after an injury (or a surgical procedure.) The fluid is of pale yellow, transparent color and contains no blood cells. Seromas typically dissolve after a few weeks, but sometimes the condition persists, potentially causing a defensive reaction from your body. The condition is especially common after breast surgeries (15-18% incidence rate.)
- A hematoma. A hematoma in your breast is a blood-filled swelling that forms right under the skin and looks like a bruising. Hematomas usually form after trauma or surgery. If untreated, hematomas can cause inflammation and fever, which can also contribute to the contracture of your implant.
Saline vs silicone implants: saline implants are considered less likely to cause capsular contractures over their silicone counterparts, although the evidence is not strong enough to form a definitive claim.
How to Know If You Have Capsular Contracture? (Symptoms)
Capsular contractures can form quickly, but usually, it’s a very gradual process. Most women simply don’t notice the slight, everyday changes in their breasts until they really stop to think about it. Besides the pain, there are several highly noticeable symptoms of capsular contracture:
- Hardened breast(s). This is the main symptom of capsular contracture and will be present in 100% of the cases. If you feel like your breasts are more firm and hard than usually, it’s a clear sign you might be experiencing capsular contracture.
- Breasts are higher up. Due to the nature of the contracture, the tightening of the protective capsule often causes the implant to move up your chest. If it looks like your breasts are higher up than usual (significantly higher), do not take chances and consult with your surgeon.
- Breasts look distorted or ball-shaped. The tightening of the protective scar tissue around the implant may cause the implant to deform. Take a close look at your breasts and look for any irregularities in the form.
- Breasts look smaller. Capsular contracture, by definition, will “squeeze” the implants inside your breasts, effectively making them look smaller. The pressure may also be enough to rupture the implant so that the liquid inside is poured out and absorbed by your body (do not worry, neither salt water inside saline implants nor the silicone gel are dangerous.)
The so-called Baker scale also helps determine how severe the contracture is:
- Grade I. The breast is soft and looks normal, the capsule is flexible.
- Grade II. The breast still looks normal, but is a little stiffened.
- Grade III. The breast looks distorted, ball-shaped and higher up than usual, it feels much stiffer than usual.
- Grade IV. Same as Grade III but the breast is even more stiff and the patient starts feeling pain.
What to Do If You Have Capsular Contracture?
If the symptoms above describe what you’re going through, we highly recommend visiting your board-certified plastic surgeon for a closer examination. If he/she is unavailable, please feel free to contact one of our practices and we’ll help you out. If untreated, the contracture is likely to remain and keep causing you pain and discomfort. There are no known major health issues that a prolonged capsular contracture can cause. Once in the doctor’s office:
- Your breasts’ MRI images will be reviewed to evaluate the contracture
- A possible repair procedure will be offered, depending on the state you’re in
There are things you can do yourself to help reduce the contracture. Massage, ultrasound capsular contraction treatment (ASPEN) and muscle-relaxing medication can all help loosen the capsule.
Can a Ruptured Implant Cause Pain?
In brief, no. Saline breast implants contain salt water inside of them. In the case where the outer layer of the implant is damaged, the salt water is simply absorbed by your body. The same goes for silicone implants. The silicone gel inside of the implants is also not considered dangerous to human bodies. It is important to add that breast implants very rarely “burst”. Unless you experience a serious trauma in your chest area, the rupture you may be experiencing is usually microscopic. Therefore, the fluid inside of your implant leaks extremely slowly, drop by drop. How to know if your implant is ruptured? As implant rupture causes no pain or discomfort, the only way to see whether your implant is broken (without a surgeon’s examination) is to visually notice that one of your breasts is smaller than the other. Can you rupture 20+ year old breast implants during a mammogram? Some of our patients feel concerned about rupturing their silicone or saline implants before getting a mammogram. The truth is—if a mammogram causes your implant to rupture, they were probably on the verge of rupturing themselves. Unfortunately, most breast implants that are 20+ years old rupture eventually. The rupture may be “silent”, which means that the silicone gel or the salt water of your saline implants leaked into a scar pocket inside of your breast, not causing any problems or altering the way your breasts look. To determine whether your implants have already ruptured, please refer to the sections above. If one of your implants ruptures, is it possible to ‘drain’ the other one? A ruptured implant may cause asymmetry in your breasts. If implant replacement is a distant option, then the other implant may be drained to achieve an acceptable look. The procedure itself is simple and can be performed right in the exam room. You will be given local anaesthesia, a needle will pierce the implant, and some of the fluid inside the implant will be removed.
When Do Implants Need to Be Replaced, Anyway?
It is a common myth that breast implants have a “lifespan” of 10 years. There are patients who successfully live well over 20 years without ever experiencing any complications. Unless there is a problem with your implants, they don’t need to be replaced. According to a recent FDA report, only about 20% of all breast augmentation patients need to go through a repair surgery within the first 10 years after the procedure. There are several factors that can cause your implants to “wear out” sooner than usual:
- If you’re an athlete or exercise frequently
- If you went through motherhood with your implants
- If you frequently sunbathe (sun exposure and temperature may affect the implants)
With that information in mind, there is no “valid until date” for your breast implants. You should only consider going for another surgery if you’re unsatisfied with how your breasts look or are experiencing a complication.
When women research breast augmentation, a big concern is their post-surgery recovery. Questions concerning duration and discomfort levels are high on their list. However, patients should be aware of all aspects of recovery to ensure a successful breast augmentation outcome.
Recovery from surgery will differ from one patient to another. Each patient has different responses in their body’s ability to heal and their individual pain tolerance. Also, implant placement, size of the implant, type of implant, and surgical technique will impact the recovery process. We want to help you understand what to expect during breast augmentation recovery with a few tips on making your recovery shorter and easier.
Recovery Restrictions and Milestones
Here is a recovery time-table estimate which provides a basic overview of what to expect during recovery. Initially, sleeping should be done on your back, not on your side or stomach. You should wear support or surgical garments until instructed otherwise. Remember, all recoveries are different and may vary.
- Two to Three Days After Surgery: Most of our patients experience mild to moderate discomfort that can be managed with pain medication. Bruising and swelling are normal. You will be fitted with compression bandages and a surgical bra for support, wound protection, and to minimize pain. Some patients may experience nausea from the anesthesia used during surgery, but it will pass relatively soon. You may take showers after two days.
- One Week After Surgery: Most patients can return to work and perform minimal physical activities. Strenuous movements like lifting, bending, and other heavy activity is restricted. You will return to our office for your first follow-up visit to remove sutures and an examination of incisions and implant placement.
- Two Weeks After Surgery: You should begin feeling normal and return to daily activities without much discomfort; however, strenuous activity and exercise are still restricted. At this time you may start taking baths again.
- One Month After Surgery: Most of our patients can begin normal exercise (although they should avoid workouts which target the chest area).
Managing Pain and Discomfort
There will be some level of pain after breast enhancement with more discomfort typically present in the first few days. Surgical technique and the patient’s tolerance for pain will determine the severity of discomfort during recovery.
Some women feel little to no pain while others need prescription medication to manage their discomfort. When implant placement is below the muscle, recovery may include more time and discomfort in comparison to procedures that place the implant above the muscle.
Breast Implant Settling
Right after the procedure, it’s normal for breast implants to sit high and feel hard, and at times the nipples point downward. Eventually, the breast implants will start to become softer and settle down to a more desirable position. On average, it takes 3 months for the breast implants to settle, but may be later or sooner, depending on the individual.
Proper incision placement and a skilled surgeon can minimize the visibility of scarring. Incision placements range from the natural breast fold to the areola (dark pigment around the nipple) location, or the armpit crease.
Dr. Waltzman will provide effective incision care protocols combining silicone gel (or tape) with medical-grade topical agents to maximize healing and minimize scar visibility.
Other Concerns You May Encounter
- Chest Pressure or Tightness: When implant placement is under the muscle, you may experience chest pressure or tightness. Your pectoral muscles now have implants below them, and they need to stretch and shape over these implants. When these muscles stretch completely, the tightness will eventually subside in about two weeks. Some patients describe this experience as like a weight on your chest.
- Engorgement: If you have experienced childbirth, you know how engorgement feels. It is the feeling of your breasts swelling because of too much milk. They become tender, warm, and at times, painful. This feeling usually subsides after one week.
- Soreness in Your Breast Creases: This discomfort is common due to the placement of the implant behind the nipple. Soreness and tenderness are a result.
Tips for a Quick Breast Augmentation Recovery
- Choose a trustworthy caregiver to help you during the first 24 hours. Most of our patients choose a friend, partner or family member to help them right after surgery.
- Leave your incision wounds alone except for authorized treatment and the changing of bandages.
- Avoid quick movements, such as jumping or running which may cause your breasts to bounce or move. This activity can shift your implants before they are completely settled.
- Sleep on your back while uplifting your pillows. This practice should continue for six weeks. It will help you get in and out of bed more comfortably and avoid shifting the implants.
- Massage your breasts as instructed by Dr. Waltzman.
- Wear loose-fitting clothes that are easy to put on and remove.
- Hydrate by drinking plenty of water and eat healthy, nutritious foods.
- Get plenty of sleep and rest.
- Wear your surgical garments or support bras faithfully until instructed otherwise.
- Follow all recovery instructions you receive from Dr. Waltzman and attend every after surgery follow-up visit.
If you are interested in more information about breast augmentation and breast augmentation recovery, please contact us by calling (562) 448-6100, or to schedule a consultation online.
The breast augmentation procedure is on high demand these days following its aesthetic benefits. If you’ve already had children, in some cases you need only a breast augemantation to restore the fullness to your breasts. If you’re interested, you can try out the surgery for mummy makeover in Sydney to bring back the young looking you. However, you might wanna understand the pain under breast implant years later prior to giving breast augmentation surgery a go.
Pain under breast implants years later is an issue which women may face years after implanting breasts. It may happen after five, ten or fifteen years. There are two main reasons for this pain occurring years after surgery.
•You may have strained muscles around your chest or
•You have capsular contracture
Remember, breast implants do not have lifespan and complications are likely to occur after few years.
As far as strained muscles near your chest area are concerned, it is not a big issue as it may happen due to either sole muscles after work-out when you put pressure on your chest or cough related illness or due to costochondritis where inflammation of joints of the ribs happen which links cartilage with bone. When you cough and as there is lesser space between your implanted breasts and bones, so a little collision occurs in rib junction and this causes inflammation which resultantly causes pain in chest.
What to do:
•Consult your doctor for anti-inflammatory medicine
•Try to reduce frequency of cough
•Use muscle relaxants
•Avoid additional movements unless your issue is resolved.
On the other hand, if you have capsular contracture problem, then it needs to be addressed immediately because it means that your body is significantly rejecting breast implants.
•It may happen due to an infection while surgery if proper measure of hygiene haven’t been kept into consideration.
•If your body has Seroma after surgery: These fluid pockets should dissolve after surgery on their own but if they don’t, they may cause inflammation.
•Hematoma is a blood filled swelling which may occur on your skin near breasts and look like a bruise. If not treated in time, it can cause fever and pain and can contracture your breast implants.
What to do:
•You must immediately consult your plastic surgeon for thorough examination.
•You may go under an MRI to identify the cause of your pain and discomfort and surgeon will evaluate your situation.
•Depending on severity of your condition, a repairing procedure will be followed by your surgeon.
Pain under breast implant years later is a concerning issue which should be addressed immediately.
Once a breast implant is in place, fibrous scar tissue forms around it, creating a tissue capsule. The body forms a protective capsule like this around any object it recognizes as foreign. The tissue capsule is usually soft or slightly firm, not noticeable, and helps to keep the implant in place. In some women, a tissue capsule forms that is unusually hard and dense. The capsule tightens around and squeezes the implant. This condition, called capsular contracture, can cause chronic pain and distortion in the shape of the breast, and it can make the breast rise higher on the chest.
Who is at risk of capsular contracture?
If you’ve had radiation therapy at any time in the past — and particularly if you had it after your initial breast reconstruction surgery — that can greatly increase your risk of developing capsular contracture. But overall, the reasons that some individuals develop capsular contracture while others do not are not well understood.
Some of the other factors that may raise the risk of capsular contracture include rupture of an implant, hematoma (a build-up of blood where tissue was removed during surgery), developing a microbial biofilm (subclinical infection) on an implant, and a genetic predisposition to forming scars.
Signs and symptoms of capsular contracture
Signs of capsular contracture, such as increasing firmness or tightness in the breast, can start to appear as early as a few months after your implant reconstruction surgery or years later.
You may want to consider corrective surgery for capsular contracture if it’s causing you chronic pain, restricted range of motion, and/or changes in the position and shape of the breast.
Corrective surgery options for capsular contracture
Some of the options for correcting capsular contracture include:
- Capsulectomy: During a capsulectomy, your surgeon will remove the existing implant and the surrounding tissue capsule and insert a new implant that is wrapped in a sheet of dermal matrix material (a skin substitute made mostly of collagen). The dermal matrix material provides an extra protective layer, and the body will form a new capsule of scar tissue around it.
- Open capsulotomy: During an open capsulotomy, your plastic surgeon will attempt to cut open the tissue capsule around the implant by making small incisions and may also remove some of the capsule. The goal is for the capsule to pop open, giving the implant more room to move around. In some cases, your surgeon will also remove your existing implant and replace it with a new one.
- Autologous reconstruction: During an autologous reconstruction, your plastic surgeon will remove your implant and reconstruct your breast with a flap of tissue transplanted from another area of your body, such as your belly or buttocks. An important advantage to this approach is that it eliminates the risk that capsular contracture will recur, as a tissue capsule will not form around a flap. However, autologous reconstruction is a more complex surgery with a longer recovery time than a capsulectomy or open capsulotomy. Learn more about autologous reconstruction.
Left image: Capsular contracture developed in the right breast and the left implant moved into a position that was too low on the chest after a bilateral mastectomy and silicone implant reconstruction.
Right image: The capsular contracture on the right breast was corrected by removing the implant and reconstructing the breast with “stacked” DIEP flap surgery. The displacement of the left implant was corrected by removing the implant, inserting a new implant, and making adjustments to the pocket of tissue that holds the implant in place. Left image: Capsular contracture developed in the left breast and chronic discomfort developed in both breasts after a bilateral mastectomy and implant reconstruction.
Right image: Corrective surgery involved removing both implants and the capsule of scar tissue surrounding each implant and reconstructing the breasts using the DIEP flap procedure. Left image: Capsular contracture developed in the right breast after a mastectomy and implant reconstruction.
Right image: Corrective surgery involved removing the implant and the capsule of scar tissue surrounding the implant and reconstructing the breast using the “stacked” DIEP flap procedure.
The photographs on this page are copyrighted materials and no reproduction or use of these photographs is permitted except with the written consent of the Center for Restorative Breast Surgery.
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Last modified on April 23, 2019 at 6:36 AM
Implant patients see problems 20 years later
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Danielle Marinovich still keeps a photograph of her late sister on the shelf of her shop in Berkeley. But the memories of her death from /*breast cancer*/ came rushing back recently, as Danielle was giving herself a breast exam.
“During a breast exam in the shower I felt a lump on my right breast, it felt abnormal, and of course I was scared and thought it was cancerous,” said Marinovich.
A series of follow-up tests revealed that the hardening in her breast wasn’t cancer, but the result of a decision Danielle had made decades ago.
“I wanted to look a little sexier, feel sexier. I thought I’d be sexier if I had larger breasts,” said patient Danielle Marinovich.
Like thousands of other women, Danielle had received /*silicone breast implants*/ while she was in her early 20’s.
“To me I thought it was going to be a onetime deal,” said Marinovich.
“She’s a classic example of someone who had implants 20 years ago. No one really told her what might have to be done in terms of maintenance or what to look for,” said San Francisco surgeon Carolyn Chang, M.D.
Dr. Chang says Marinovich’s condition is a relatively common side effect that typically emerges decades after implant surgery — when friction from the implant causes the interior wall of the breast to harden.
“When it goes in its . Then scar tissue forms around it. If there’s a little space between the scar tissue and the implant, then it’s soft and it sits nice in the body. If the scar tissue contracts it looks ,” said Dr. Chang.
The condition, known as encapsulation can also cause severe pain. So Marinovich ultimately opted to have her implants replaced.
ABC7 got to witness how Dr. Chang performed the procedure on another patient suffering similar side effects. While silicone implants were pulled from the market in the 1990’s after allegations of leakage, they were reintroduced three years ago, and are now considered to be safe. But Dr. Chang says issues are still surfacing from surgeries performed decades ago.
“I think the basic problem was that we as physicians were not educating patient that these implants potentially need to be replaced over the lifetime. And so what I was seeing 20 years later was implants that were frankly ruptured and were not taken care of,” said Dr. Carolyn Chang, M.D.
Implant patients are now taught to recognize potential trouble signs: breast pain, deformities of the breast, and encapsulation. They are also are warned that the implants will probably need to be replaced once or even twice in a lifetime.
In Marinovich’s case, Dr. Chang placed new implants — this time saline — beneath the muscle under her breast, to allow for easier use of cancer screening tools like mammograms. However, Danielle is still uncertain about any future replacements.
“Because of history and what I know now, that’s a really hard question for me to answer if I would or not. As I get older, I may not care as much. I may opt not to put them back in,” said Marinovich.
Dr. Chang says that screening procedures to detect problems such as potential leakage have also improved significantly. Patients are now given an MRI scan, three years after surgery, and are advised to have follow up scans every two years after that.
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FDA: Breast implant problems grow with time
In this Dec. 11, 2001 file photo, a silicone gel breast implant is shown at Mentor Corp. manufacturing facility in Irving, Texas. Federal health officials sid Wednesday, June 22, 2011, the latest data on silicone breast implants show they are relatively safe, despite frequent complications that lead about one in five women to have the implants removed within ten years. (AP Photo/Donna McWilliam, file)
Don’t expect breast implants to last for life, the government warned Wednesday: About 1 in 5 women who receive them for cosmetic reasons will have them removed within 10 years, and those odds are even higher for cancer survivors.
It’s not the first time the Food and Drug Administration has issued such a warning. But the agency repeated it Wednesday after reviewing new data on silicone-gel breast implants five years after they returned to the market following a health scare. The agency concluded the implants are basically safe as long as women understand they come with complications. Those include painful scar tissue and ruptured implants.
“The longer you have the implant, the more likely you are to have complications,” said FDA medical device chief Jeff Shuren. He said women should get regular checkups including scans to make sure the implants haven’t ruptured.
While FDA’s safety review concentrated on silicone-gel implants, the agency’s updated advice booklet for women makes clear that saline-filled versions come with the same complications – women getting those wind up back on the operating table, too.
Plastic surgeons say they’ve long told women about those risks.
“It doesn’t discourage a single one of them, which is pretty amazing,” said Dr. Michael Zenn, vice chief of plastic surgery at Duke University Medical Center. “This requires almost lifetime maintenance when you have a breast implant in. If you’re not telling patients that, you do them a disservice.”
Wednesday’s update is the latest in a 20-year saga over the safety of breast implants. The FDA banned the silicone-gel type in 1992 amid fears they might cause cancer, lupus and other diseases. But when research ruled out most of the disease concern, regulators returned the implants to the market in 2006 – with the requirement that manufacturers continue studying recipients to see how they fare long-term.
Breast augmentation remains the most popular cosmetic surgery in the U.S., with nearly 300,000 women undergoing it last year. According to the American Society of Plastic Surgeons, more than 70,000 others received implants for breast reconstruction. Silicone-gel implants are the most common kind.
Based on that data, FDA said Wednesday that 20 percent to 40 percent of patients who have implants for cosmetic reasons will need another operation to modify or remove them within eight to 10 years.
For reconstruction patients, the number is even higher at 40 to 70 percent, FDA said.
The most common complication remains scar tissue that hardens around the implant, and that can become severe enough to warp the shape of the breast or cause pain. Other problems include implant rupture, wrinkling and a lopsided appearance, according to the report.
The research also showed a small link with a very rare form of cancer known as anaplastic large cell lymphoma. The agency has learned of 60 cases of the disease worldwide, among the estimated 5 million to 10 million women with breast implants.
Why are reconstruction patients so much more likely to need another operation?
Radiation for breast cancer damages the skin so that over time it becomes stiffer, said Dr. Evan Garfein, a plastic and reconstructive surgeon at New York’s Montefiore Medical Center. It’s not uncommon for a woman who got two implants – so that both sides start out matching – to have the radiated side eventually appear tighter and higher on the chest as the tissue around it contracts. Also, women getting an implant after a mastectomy don’t have a natural layer of breast tissue to cushion it.
But Zenn said women getting cosmetic implants also need to understand that their breasts also will change with age or weight gain – and even if the implant doesn’t rupture or develop scar tissue, the skin and fat around it can droop or sag in unattractive ways. He advises women considering pregnancy to put off implants, because their breasts tend to change afterward, and says he won’t perform large implants that bring a greater risk of later revisions.
The FDA’s safety endorsement is primarily based on studies conducted by the two U.S. manufacturers of the products, Allergan Inc. and Johnson & Johnson’s Mentor unit.
But industry critics point out that most of the studies are still incomplete, and many women have already dropped out.
For example, only 58 percent of women enrolled in a 1,000-patient study of Mentor’s implants are still accounted for after eight years. A larger study of 40,000 women conducted by Mentor has lost nearly 80 percent of its patients after just three years. FDA officials said such studies should aim for a 85 percent follow-up rate.
Dr. Diana Zuckerman of the National Research Center for Women and Families said most medical journals would not publish the studies cited by the FDA because of the missing data.
“Once a medical product is approved, the manufacturers have no incentive to do these required studies properly,” Zuckerman said. “So, we end up with useless information, which is what has happened with the largest, most important studies of silicone gel breast implants.”
The FDA said it is working with Allergan and Mentor to increase study participation, including allowing participants to answer questions online or over the phone.
The head of the leading U.S. plastic surgery society said many patients skip follow-up appointments because they aren’t having any problems.
“When women are happy with their implants they tend to feel that a regular follow-up is pointless – it becomes a nuisance and an unnecessary expense,” said Dr. Phillip Haeck, president of the American Society of Plastic Surgeons.
FDA sees possible cancer risk with breast implants
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Citation: FDA: Breast implant problems grow with time (2011, June 22) retrieved 2 February 2020 from https://medicalxpress.com/news/2011-06-fda-silicone-breast-implants-safe.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.
Constance M. Chen, MD, FACS
By Dr. Constance M Chen
In 2017, almost 400,000 women underwent surgery with breast implants – whether for cosmetic breast augmentation or for breast reconstruction after mastectomy. Despite significant improvement in implants since they were first introduced in the 1960s, however, studies by the implant manufacturers have shown that within seven years, 50% of women with breast implants will undergo another operation to fix problems with their implants.
One common problem with breast implants is the development of capsular contracture, a condition in which the scar tissue that forms around the implant becomes hard and painful. Scar tissue is the body’s natural response to the presence of any foreign body. With breast implants, the body creates a barrier of scar tissue around the implant to wall it off and protect it from the rest of the body. This barrier, or capsule, may be soft, flexible, and barely noticeable or it may become hard and painful, like a hard shell that develops around the implant and that may subsequently distort the breast. Capsular contracture is essentially a tightening – or contracting – of the scar tissue. Symptoms usually emerge gradually and may be noticed first as a feeling of mild tightening. As contracture increases, the breast may appear misshapen and become very firm and painful, especially when lying on it.
There are several factors that may precipitate capsular contracture, such as a low-grade bacterial infection, hematoma (blood pooled in the breast pocket), and seroma (fluid collected in the breast pocket). Studies suggest that an implant with a textured surface may be more protective against capsular contracture than an implant with a smooth surface, but textured surfaces also place patients at higher risk of infection and large cell anaplastic lymphoma. Since implants are foreign bodies, they do not have a defense mechanism against infection. Placing the implants under – rather than above – the pectoral muscle can reduce the risk of capsular contracture due to the constant massaging action of the pectoralis muscle, but it can also lead to more pain due to the unnatural position of the implant. Sometimes, exercises or massage can be helpful after implantation to break up hardened scar tissue. Ultimately, it is impossible to prevent the development of an implant capsule altogether, as scar tissue is formed when the body heals.
In general, capsular contracture is treated by removing the implant. Not all surgeons remove the capsule, because a complete capsulectomy is a very meticulous and time-consuming procedure. A complete capsulectomy requires removing capsular material that may be attached to the chest wall or ribs, which can risk damage to surrounding structures including the lung. A partial capsulectomy removes only some of the capsule, leaving some material behind. A capsulotomy (as opposed to a capsulectomy) involves using electrocautery to make breaks in the capsule to release the tightness while leaving the actual capsule in place – much like cracking a shell to release it but not actually removing any of the shell itself. Other surgeons remove the implant and leave the capsule alone entirely, believing that the capsule will eventually be resolved by the body. Postoperative imaging has actually shown that the capsule sometimes does get resorbed by the or it thins out over time. Implant removal alone is the quickest, easiest, and possibly safest procedure, as even complete capsulectomy can and often does lead to a return of the contracture if a new implant is placed.
That said, there are good reasons to remove the entire capsule with the implant. When the implant is removed with no implant replacement, a complete capsulectomy reduces the likelihood of a subsequent seroma because the raw tissue surfaces can heal and adhere properly to each other without the residual capsule in the way as a barrier. It can be very helpful to remove the entire capsule. The capsule contains a biofilm that may include fragments of silicone, bacteria, calcification, and inflammatory cells that can cause problems if left in the body. By removing the implant and the entire capsule, the healthy tissues can heal completely.
In March 2017, the Food and Drug Administration (FDA) issued a press release about a rare cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), which is associated with breast implants women receive after surgery cosmetic or reconstructive surgery.
In May 2017, the New York Times also picked up the topic, highlighting the struggles of a few women who developed BIA-ALCL. The majority of women had received a textured-surface breast implant during their breast procedure. This does not mean the breast cancer comes back – BIA-ALCL is actually a lymphoma, a cancer that affects the lymph nodes.
Though BIA-ALCL can become a serious disease, there are three things we want women in North Texas to know:
- BIA-ALCL is rare. One in 30,000 women with textured-surface breast implants may develop it. The FDA has reported 359 cases of BIA-ALCL in the United States as of February 1, 2017, and nine women have died from the disease.
- Breast implants are safe. In fact, they’re among the most-studied devices in medicine. BIA-ALCL appears to be associated with textured-surface breast implants only, which account for a small number of implants.
- Getting breast implants is a personal choice. If you choose to do it, we’ll make sure you are well-informed of the benefits, risks, and available options.
Though BIA-ALCL is rare, it’s important that women familiarize themselves with the symptoms, how we diagnose and treat the disease, and the health follow-up guidelines we recommend if you choose to get breast implants after breast cancer surgery.
What BIA-ALCL symptoms should you look for?
The most common symptom of BIA-ALCL is excessive fluid buildup around the breast implant, which can cause pain, swelling, or lumps in the breast or armpit.
Symptoms usually occur between three and 14 years after implant placement. It is important to recognize the symptoms and see your plastic surgeon should they occur. If you are not experiencing any problems with your implants, there is no reason to be alarmed or have them removed. When BIA-ALCL does occur, it almost always can be cured.
It’s important to note that breast implant-associated ALCL seems to be related to textured-surface breast implants. The FDA reports that 28 of the 359 women who developed BIA-ALCL had smooth-surfaced implants. However, these women likely had textured-surface implants or textured-surface tissue expanders prior to their smooth-walled implants, which may have contributed to the inflammation.
Smooth-surface implants are more commonly used for cosmetic breast surgery. Textured surface implants are more commonly used during reconstructive procedures but may be used for cosmetic purposes as well. The American Society for Aesthetic Plastic Surgery Inc. (ASAPS) estimates that in the United States about550,000 breast implants are placed each year. Of these, fewer than 13 percent are textured-surface breast implants.
This doesn’t mean that textured-surface implants are unsafe. The vast majority of women who have these implants will never develop health issues because of them.
How is BIA-ALCL diagnosed and treated?
Researchers think that if the tissue around the implant and the capsule become inflamed, fluid builds up, damages the cells, and can cause cancer to develop in the fluid. If the disease progresses, it enters the capsule, a natural covering that the body builds around any foreign object, such as a breast implant, to protect the surrounding tissue. And if it progresses from there, it can invade other tissues, including the lymph nodes. This is why recognizing the symptoms is critical to timely diagnosis and treatment when it does occur.
We ask that women see us annually for a breast wellness check after implant placement. A patient’s well-woman exam with their gynecologist should also include a breast exam.
The fluid is the first thing we check in a patient with a new onset fluid collection around their breast implant. We’ll draw a sample of the fluid and send it to our lab to screen for CD30, a specific marker that indicates lymphoma. It’s not terribly uncommon for fluid to accumulate around breast implants and if it does, that does not mean you in fact have developed the disease.
Breast implant-associated ALCL can be cured by removing the breast implant and its capsule. If the cancer has spread beyond the lymph nodes, you may need to undergo chemotherapy. After three years, 93 percent of BIA-ALCL patients are disease-free when the condition is detected and treated early, according to ASAPS data. That’s an excellent prognosis.
You have options after breast cancer surgery
Undergoing breast reconstruction after breast cancer is a personal decision. Some women choose implants. Some undergo breast reconstruction from their own body tissue. And some women forgo reconstruction of any kind.
Our team would never push you into a decision after breast cancer. Our role is to present you with your options, recommend which you may be the best candidate for based on your unique condition, and provide education to help you make your choice.
To date, none of our patients have developed this condition, though we have helped in the care of several patients over the years who have developed it. By continually educating ourselves and our patients, hopefully we can help more women feel comfortable about their options regarding breast implant surgery.
A recent patient of mine just had a breast augmentation. She is thrilled with the change in her figure, and loves her results, but noticed about 1 week after her operation that she started feeling pain, electrical shocks, and pins and needles around her breast, especially going towards her areolae and nipples.
So, what is it?
Nerves and Swelling/ Paresthesia and Dysesthesia
The feelings of “electrical shocks” (medical term = paresthesia) and “pain” or “uncomfortable feeling” (medical term = dysesthesia) are fairly common after breast augmentation.
There are nerves that supply sensation and feeling to the overall breast and nipple. When you have a breast augmentation procedure, the surgery will cause some swelling, compressing the nerves in the area. As the swelling goes away, the nerve feeling becomes more normal, and the nerves respond by sending signals of “electrical shock”, “pins and needles”, “pain”, or other similar feelings toward the nipple and in the overall breast.
What To Do?
Fortunately or unfortunately, there’s not much to do except let the swelling go down. Icing and elevating your chest will help reduce any swelling in your breast augmentation area.
Wearing a good surgical support bra or sports bra will also help, since the less motion your breasts have after surgery, the less “paresthesia” and “dysesthesia” you will feel.
Pain medicine and anti-inflammatory medications may also help to reduce the pain and swelling, but take it with the advice of your plastic surgeon- too many anti-inflammatories right after your breast augmentation procedure may actually cause any post-op swelling and bruising to linger.
When Will It Go Away?
Typically, these feelings will rapidly go away several weeks after surgery. As long as your swelling after your breast augmentation goes away, then your nerves in your breasts will settle down, and should revert to more normal feelings in your breasts over time.
Removal of the implant
There are a variety of problems that could require removal of the implant. These problems include rupture from a sharp blow or from normal wear over time, as well as adverse effects such as severe capsular contracture and calcium deposits. It is not known how many women have had to have their implants removed because of implant rupture or other problems.
Additional New Zealand Information
Specific information about an implant is usually provided to the surgeon by the manufacturer of the implant. In some cases the manufacturer may include a statement which exempts it from liability or limits its liability in respect of the implant.
This may complicate your chances of legal recovery against the company and/or your surgeon if you go ahead and have a breast implant inserted and then experience complications.
You should ask your surgeon to show you the manufacturer’s statement concerning liability in their data sheet on the particular implant that you are considering. If the surgeon is unable to show you any documentation then you should ask him or her to find out whether the company concerned attempts to limit its liability. If you have any concerns in this regard you should discuss it with your lawyer without delay, and before undertaking any surgery.
The data sheet may also state what action should be taken if the implant ruptures. This should be discussed with your surgeon. Does the manufacturer make any comment about replacing the implant if it should rupture?
Your surgeon may have additional information for you about silicone gel-filled breast implants, and you should discuss any concerns you may have before consenting to the operation.
Durability of implants
Implants can last from a short time to many years, depending on the woman and the implant. They should not be considered as lifetime implants. Check the data sheet provided by the manufacturer for the “life expectancy” of the product that is being recommended for you. You can get the data sheet from your surgeon.
Change of Name or Address on the Register
If you change your name or address, remember to advise your surgeon of the details so that the register can be amended.
If your surgeon is no longer practising you should advise the surgeon who has taken over your care.
The Royal Australasian College of Surgeons (New Zealand Section of Breast Surgery) and the New Zealand Association of Plastic and Reconstructive Surgeons have agreed to hold the patient register entries of any of their members who are no longer practising, if their practice has not been taken over.
The Ministry of Health could forward your changed name or address to the appropriate organisation so the register can be amended. The address to write to is:
Ministry of Health
PO Box 5013
Make sure you also include the name and address of the surgeon who performed your operation and the date of the operation. (It would be helpful if you could photocopy the register entry in this booklet and enclose it with your letter).
Declaration and Register Entry Forms
Note: This document is a PDF file which requires Adobe Acrobat Reader to enable viewing – to download Adobe Acrobat Reader
Nipple pain or sensitivity after breast augmentation is called dysesthesia or hyperesthesia. Occasionally, after breast augmentation a women can have nipples that feel tender, sore and sometimes have a burning sensation. The condition is often caused by stretching of the nerves, either at the time of surgery or due to the size and location of the breast implant(s). A stretched or bruised nipple will often give off erratic nerve impulses which often feel like pins and needles, a deep ache or a burning type of sensation. Sometimes clients describe the pain as coming from under the implant. Often there will be a numbness or tingling feeling which also comes from disturbed nerves or nerves that are growing back after surgery.
Often clothing or bra can rub against the area (even lightly) causing this discomfort. On rare occasions there can even be disruptions in sleeping. The treatment for this type of sensitivity is usually massage therapy. Massage of the affected area with a moisturizing cream can help to desensitize the area. Some clients have found that a few units of BOTOX in this area can relieve the pain. Most of the time this hypersensitivity goes away after the nerve calms down and stops being inflamed by the disruption causes by the implant.
Nerves often will cause pain as they are healing and “waking up.” You know how painful and hypersensitive your leg is when it “falls asleep” and then wakes up? You know that pins and needles type of feeling? Well, that’s kind of what’s going on in your breasts after having a breast augmentation. When the implant stretches and rests on the nerves in your breast and nipple tissue, the nerves become inflamed and often cause pain, tingling and burning. Generally these symptoms are present the first 1 to 3 weeks and then get much better.
Many of our clients in Hilo and other areas of the islands see the sensitivity dissipate after the first month and have no complaints after month two. Everyone is a little different but do not be alarmed if you are experiencing some discomfort around your nipples after breast augmentation. It is a common and expected occurrence. Please do not hesitate to contact our office with any concerns. We are here to help all of our clients in Hilo and elsewhere in whatever way we can.