When do breast implants need revision. How to recognize implant complications. What are the risks of ignoring breast implant issues. Why might breast augmentation results change over time. How often should breast implants be replaced.

Recognizing Pain and Discomfort: A Key Indicator for Breast Implant Revision

Breast augmentation surgery is a popular cosmetic procedure, but like any medical intervention, it may require follow-up care. Pain and discomfort associated with breast implants can be a significant cause for concern. These symptoms may indicate various issues that necessitate a breast implant revision.

What are the potential causes of breast implant pain?

• Capsular contracture
• Damaged lymph nodes
• Developing seroma
• Pinched nerves
• Poor implant placement
• Implant rupture or leakage (particularly in silicone implants)

It’s crucial to understand that persistent pain or irritation is not a normal outcome of breast augmentation surgery. If you’re experiencing ongoing discomfort, it’s essential to consult with your surgeon promptly. In some cases, patients may find that their implants are causing enough discomfort to disrupt their daily activities, especially if the implant used was too large or poorly placed.

Implant Rupture: Understanding the Signs and Risks

Implant rupture is a serious complication that can occur due to various factors, including intense physical pressure or the natural aging of the implant shell. The symptoms and diagnosis process differ depending on the type of implant.

Saline Implant Rupture

How can you identify a ruptured saline implant?

A rupture in a saline implant typically results in a rapid deflation of the affected breast, making it relatively easy to diagnose. The saline solution inside these implants is similar to IV solution and is safely absorbed by the body. However, this doesn’t mean you should ignore the issue.

Silicone Implant Rupture

Why are silicone implant ruptures harder to detect?

Silicone implant ruptures are more challenging to identify without medical intervention. The viscous silicone gel inside these implants leaks out slowly, often not causing immediate visible changes. Diagnosis typically requires an ultrasound or MRI.

While a ruptured implant isn’t a life-threatening emergency, it’s crucial to have the damaged implant removed promptly. This action helps prevent potential complications such as infection or the development of excessive internal scar tissue.

Bottoming Out: When Implants Fall Below the Breast Crease

Bottoming out is a condition where the breast implant gradually falls below the natural breast crease. This complication can occur when the skin and tissue are unable to adequately support the implant.

What factors contribute to implant bottoming out?

• Large or heavy implants
• Post-surgery pregnancies
• Age-related skin laxity

How can you distinguish between natural breast drooping and bottomed-out implants?

Unlike natural breast ptosis where nipples fall with the breast tissue, bottomed-out implants cause nipples to move upward as the implants descend. Patients may also be able to feel and see the outline of a bottomed-out implant, creating an unnatural appearance.

Implant Movement and Rotation: Addressing Displacement Issues

While it’s normal for breast implants to settle into a slightly different position over time, significant movement or rotation can be problematic. This condition, known as implant displacement, can manifest in several ways.

Types of Implant Displacement

1. Lateral displacement: Implants move too far away from the chest midline
2. Symmastia: Implants merge in the middle of the chest (rare complication)
3. Implant rotation: More noticeable in teardrop-shaped implants

What causes implant displacement?

Displacement often occurs when the implant pocket is too large or when too much tissue is removed near the breastbone. In the case of symmastia, the muscle between the breasts may detach, leading to the “uniboob” appearance.

Implant rotation is particularly problematic for teardrop-shaped implants, as it can result in a top-heavy, unnatural breast appearance. Round implants may also rotate, but the effect is less noticeable due to their symmetrical shape.

Changes in Implant Shape: Identifying and Addressing Asymmetry

Alterations in implant shape can occur due to various factors, including rupture, shifting, rotation, bottoming out, or other forms of displacement. These changes often happen asymmetrically, affecting one breast more than the other.

Why is asymmetry a concern in breast implants?

While asymmetry may not pose immediate medical risks, it can cause significant emotional distress for patients. Uneven breasts can make it challenging to find properly fitting bras and clothing, impacting self-esteem and quality of life.

Even if both implants change shape, they may not do so in the same manner, further exacerbating the asymmetry. This situation often necessitates a breast implant revision to restore a more balanced and natural appearance.

Capsular Contracture: When Scar Tissue Becomes Problematic

The formation of scar tissue is a normal part of the healing process after any implant surgery, including breast augmentation. In most cases, this capsule of scar tissue helps support the implant and keeps it in place. However, in some instances, the body may react excessively, leading to a condition known as capsular contracture.

Understanding Capsular Contracture Grades

Capsular contracture is classified into four grades, ranging from normal to severe:

• Grade 1: Asymptomatic, doesn’t interfere with implant results
• Grade 2: Minor cosmetic symptoms
• Grade 3: Noticeable firmness and distortion
• Grade 4: Severe hardening, pain, and significant distortion

What causes capsular contracture?

The exact cause of capsular contracture isn’t fully understood, but several factors may contribute:

• Bacterial contamination
• Hematoma or seroma formation
• Genetic predisposition
• Radiation therapy
• Smoking

Treatment for capsular contracture often involves surgical intervention to remove the hardened scar tissue and replace the implant. In some cases, additional measures such as the use of acellular dermal matrix may be employed to reduce the risk of recurrence.

The Importance of Regular Implant Monitoring and Maintenance

While breast implants are designed to be long-lasting, they are not considered lifetime devices. Most surgeons recommend considering implant replacement or removal after 10-20 years, even in the absence of complications.

How often should you have your breast implants checked?

It’s advisable to have your breast implants examined by a board-certified plastic surgeon annually. For silicone implants, the FDA recommends MRI screenings three years after the initial surgery and every two years thereafter to check for silent ruptures.

Proactive Measures for Implant Longevity

To maximize the lifespan of your breast implants and minimize the risk of complications, consider the following tips:

• Maintain a stable weight
• Wear supportive bras, especially during physical activities
• Avoid smoking and excessive alcohol consumption
• Follow your surgeon’s post-operative instructions carefully
• Report any changes in your breasts promptly to your surgeon

By staying vigilant and addressing potential issues early, you can help ensure the longevity of your breast augmentation results and maintain your overall breast health.

Navigating the Decision for Breast Implant Revision Surgery

Deciding to undergo breast implant revision surgery is a personal choice that should be made in consultation with a board-certified plastic surgeon. This procedure can address a wide range of issues, from cosmetic concerns to medical complications.

Common Reasons for Breast Implant Revision

• Desire to change implant size or type
• Addressing complications like capsular contracture or rupture
• Correcting implant malposition or asymmetry
• Updating older implants as a preventative measure
• Removing implants altogether (explantation)

What should you expect during a breast implant revision consultation?

During your consultation, your surgeon will:

1. Evaluate your current implants and overall breast health
2. Discuss your goals and concerns
3. Explain the available options for revision
4. Provide a personalized treatment plan
5. Address any questions or apprehensions you may have

It’s essential to choose a surgeon with extensive experience in breast implant revision surgeries, as these procedures can be more complex than primary augmentations. Don’t hesitate to ask about their qualifications, see before-and-after photos of their previous revision cases, and inquire about the techniques they use to achieve optimal results.

Recovery and Expectations After Revision Surgery

The recovery process following breast implant revision surgery can vary depending on the extent of the procedure and the techniques used. Generally, patients can expect:

• Initial discomfort and swelling for the first few days
• Restricted physical activities for several weeks
• Gradual improvement in breast appearance over several months
• Follow-up appointments to monitor healing and results

Your surgeon will provide detailed post-operative instructions to ensure a smooth recovery and optimal results. It’s crucial to follow these guidelines carefully and report any unusual symptoms promptly.

By addressing implant issues early and choosing an experienced surgeon for your revision, you can restore the appearance and comfort of your breasts, enhancing both your physical well-being and self-confidence.

Seven signs you need a breast implant revision

While it is expected for patients to replace their breast implants after 10-20 years, there are several reasons they may need to be replaced sooner.

If your breast augmentation does not deliver the natural-looking results you were hoping for, you experience complications with your implants or you have noticed your natural breast skin aging and sagging, a breast implant revision can help.

Here are seven common signs you need revisionary surgery.

Your breast implants are causing pain or discomfort

Painful or uncomfortable implants can indicate a number of issues that require a breast implant revision, including capsular contracture, damaged lymph nodes, a developing seroma, pinched nerves or poor implant placement. If you have silicone implants, pain may be a sign your implant has ruptured or is leaking.

Even if there is no serious issue causing pain, some patients find implants are uncomfortable enough to disrupt their daily lives, especially if the implant used was too large or poorly placed.

Regardless of the cause, persistent pain or irritation is not a normal result of breast augmentation surgery. Patients who are experiencing either should schedule an appointment with their surgeon.

Your breast implant has ruptured

Implant rupture can be caused by abrupt or intense physical pressure (like in a car accident) or through the aging and weakening of the implant shell.

A rupture in a saline implant causes a nearly immediate deflation of the affected breast, making it easy to diagnose. The saline solution inside the implant is the same as IV solution and is easily absorbed by the body.

By contrast, ruptures in silicone implants cannot be diagnosed without an ultrasound or an MRI because the viscous silicone gel inside the implant leaks out slowly.

While the rupture of a breast implant is not a life-threatening emergency, it is important to have the damaged implant removed to prevent infection or the development of excessive internal scar tissue.

Your breast implant has bottomed out

If the skin and tissue cannot adequately support the breast implant, it is possible for the implant to gradually fall below the breast crease, or “bottom out.” This condition is more common with large or heavy implants, but post-surgery pregnancies or skin laxity due to age can also cause an implant to bottom out.

Drooping breasts are not uncommon. But unlike breasts that naturally fall over time, where nipples fall with the breast tissue, bottomed-out implants cause nipples to move upward as the implants fall lower. It is also common for patients to be able to feel and see the outline of a bottomed-out implant.

Your breast implant is moving or rotating

It is normal for breast implants to settle into a slightly different position over time. It is not normal for implants to move to a dramatically different location on the chest wall. This is called implant displacement, and there are several ways an implant can shift.

Lateral displacement of implants (implants moving too far away from the midline of the chest) can occur when the implant pocket is too large. Symmastia, or implants merging in the middle of the chest, is a rare complication caused when too much tissue is removed near the breastbone, which in turn causes the muscle between the breasts to detach.

An overly large implant pocket can also result in implant rotation. Patients may not be able to tell if a round implant has rotated, but a rotation of teardrop implants yields a top-heavy, unnatural appearance of the breast.

Your breast implant has changed shape

Implant shape can change if the implant ruptures, shifts, rotates, bottoms out or becomes otherwise displaced.

Changes in implant shape usually occur asymmetrically, meaning in one breast or the other. Even if both implants change shape, they may not change in the same way. This asymmetry is not medically risky, but it can cause patients significant emotional distress and make it very difficult to find bras and clothing that fit properly.

Your breast implant is causing capsular contracture

The formation of scar tissue is a normal part of the healing process after placing any kind of medical or plastic surgery implant. Usually, this process is a good thing because the capsule of scar tissue helps support the implant, keeping it from slipping.

In some cases, however, the body mistakes the implant for a dangerous foreign object and creates excessive amounts of scar tissue to isolate it. Known as capsular contracture, this overproduction of dense, hard tissue around the breast implant can affect the success of the augmentation procedure.

There are four grades of capsular contracture, ranging from normal to severe. Grade one is asymptomatic and doesn’t interfere with the results of the implant. Grade two capsular contracture has only minor cosmetic symptoms, leaving the breast normal in shape but firmer to the touch.

Capsular contracture of grades three and four causes hard, misshapen and overly round breasts that look and feel unnatural. Grade four contracture also often results in breast pain. Patients with either grade three or four capsular contracture usually require a breast implant revision.

You are unhappy with your breast size

While most patients are happy with the results of their breast augmentation, some patients find they wish they had gotten a different size of implant – larger or smaller.

If you want to change the size of your implants, most doctors will recommend waiting about a year after your initial surgery before proceeding. Not only will this waiting period allow your body to fully heal, but it will also give your implants time to settle into their final position before you make this major decision.

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.

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 click here.

Author:Dr Lily Vrtik

About: Dr Lily Vrtik is a fully-qualified and accredited aesthetic, plastic & reconstructive surgeon practising in Brisbane, Queensland (QLD), Australia.

Pain after mammoplasty – what to do?

Written on 18 Jun 2020

Pain after mammoplasty – what to do?

Contents

1. What hurts after mammoplasty

2. When does the pain go away after breast augmentation

3. The implant is placed under the muscle

4. Ribs hurt after mammoplasty and

5.What to do with unbearable pain

There are exceptions for everything in medicine, and normally, the severity of pain symptoms after breast augmentation surgery is assessed by patients as acceptable, tolerable. But for everyone who has a low pain threshold, it can be difficult to survive the first days after surgery and the stages of healing. One thing remains unchanged: it is impossible to completely eliminate the manifestation of pain after mammoplasty – this is a natural reaction of the body to surgical intervention and the installation of implants.

What hurts after mammoplasty

Anesthesia is still effective immediately after breast augmentation surgery, and patients will not have to experience pain of a high degree. In addition, with the appearance of obsessive, disturbing pain, while in a hospital, medical staff can offer painkillers.

Localization of pain: chest area, patients feel them like pain in the ribs. Less often – reflected in the back and upper abdomen (epigastrium), burning and discomfort can also be felt directly in the sutures themselves.

Such pain symptoms are normal, because during a surgical operation, at the stage of implant installation, soft tissues are moderately injured, the integrity of nerve fibers is reversibly disturbed.

Popular topics and articles:

When will the pain after breast augmentation go away? How does the residual effect of anesthesia pass? Further, during the day, pain sensations are experienced in different ways:

• Patients with a low pain threshold may find it difficult to tolerate the symptom and require pain medication;
• The widest group of operated patients feels pain as neutral, as one that can be tolerated without experiencing any obvious discomfort. Analgesics are prescribed only under special circumstances;
• Less common – patients with a high pain threshold – do not notice disturbing sensations, taking painkillers is not required.

How patients perceive pain in everyday life will determine how much they experience this symptom after breast augmentation surgery.

Pain, burning, reflected sensations subside during the first day, then, during the first week after mammoplasty, any degree of pain severity disappears completely.

If symptoms persist for more than a week or cause unacceptable discomfort, accompanied by severe swelling, it is necessary to visit the surgeon for an unscheduled examination.

Implant placed under the muscle

This is the general name for two types of augmentation (breast augmentation with implants) – total submuscular arthroplasty, or placement of the implant partially under the muscle and mammary gland. In both cases, it is not possible to avoid the occurrence of pain, but the soft tissues injured during the operation are restored as standard, within the first week after mammoplasty.

In most cases, patients notice a reduction in this period to 2-3 days, then the pain is either not felt, or felt as a background that does not interfere with everyday life. There is no prohibition on taking painkillers if there is no individual reaction to painkillers. Special formulations, most often, are not required, standard NSAIDs are enough, non-steroidal anti-inflammatory drugs – those that are often taken for colds.

Ribs hurt after mammoplasty

It would be more correct to say that it is the soft tissues that are close to the ribs that hurt, and not the costal bones themselves, the pain of which belongs to rare diseases. Such manifestations are a good example of reflected pain: those that arise in one part of the body, but are given to those located nearby.

Mandatory examinations before mammoplasty, tests allow to exclude any risks of surgery in patients with chronic degenerative diseases of bone tissue. If any pathology is found that is an obstacle to breast augmentation with the help of implants, such a surgical operation is not performed.

How to deal with unbearable pain

Contacting your plastic surgeon is the only correct way to find a solution in such a situation.

Under no circumstances is it allowed to perform exercises that in everyday life would help restore the mobility of muscle tissue. It is also forbidden to take baths (steaming), swimming, increasing physical activity or returning to the previous level of stress (running, fitness, etc.). It is strongly not recommended to remove compression garments, even if wearing them causes more discomfort than muscle recovery.

For more information on rehabilitation and recovery after breast augmentation surgery, see Consequences of Breast Augmentation. Rehabilitation and recovery

The main rule in the event of acute pain is not to take any of the actions that are described in large numbers on patient communication forums, and also not to use folk methods.

In the history of plastic surgery there is also no description of the positive experience of using warming compositions, which in everyday life, without surgical operations, help to cope with muscle strain. Apply such creams, gels, ointments is prohibited.

If there is a sudden onset of acute pain in the chest muscles, take a relaxed half-sitting position and observe the further nature and severity of pain for 15-20 minutes. If the symptom has resolved after the resting position has been taken, the daily activities should be reviewed and more time should be spent at rest. In the absence of positive changes, you should consult a doctor: you may need to consult a cardiologist, osteopath or other highly specialized specialists.

The main rule in the event of acute pain is not to take any of the actions that are described in large numbers on patient communication forums, and also not to use folk methods.

Popular topics and articles:

Postoperative recovery, Breast augmentation

What to do if the chest hurts after mammoplasty?

Mammoplasty is an operation to change the shape and size of the breast. Through plastic surgery, you can both enlarge the breast with the implantation of endoprostheses, tighten the sagging mammary gland, and reduce it by removing excess adipose tissue and skin.

Why there is pain after mammoplasty

When a woman experiences discomfort due to imperfection in shape, breast size or asymmetry, she turns to surgeons with a question about the possibility of mammoplasty.

During augmentation mammoplasty, implants are placed that are foreign to the woman’s body. It takes time for them to engraft in soft tissues, for the woman’s body to adapt to changes. Therefore, in the postoperative period, you should be patient and follow all the doctor’s prescriptions regarding not only taking medications, but also the regimen of physical activity, as well as self-care.

Pain after breast augmentation is associated with traumatization of tissues during the operation, their stretching due to the installation of implants. The severity of pain depends on the surgical approach, the volume and technique of the operation, and the sensitivity of the patient. The placement of the implant also affects the intensity of pain sensation: if it is installed under the breast, the pain will be less pronounced than in cases of installation under the pectoral muscle.

In the first weeks after the operation, discomfort will also be associated with breast swelling. Sometimes swelling extends to the abdomen, which is considered normal in this period. Perhaps the presence of hematomas, which quickly resolve.

There may be back pain, which usually disappears on average 2 weeks after the plastic surgery.

How long will you have to endure?

In the first week after the operation, the pain is the most intense. Each patient is different, but usually the pain decreases and gradually disappears already 2 weeks after the operation.

If the feeling of pain does not go away or, on the contrary, its intensity increases, you should notify the attending physician, tell about your feelings, and, if necessary, come for an examination. Pain accompanies the healing process, but can be an important signal of the onset of the inflammatory process.

An important point that requires special attention is the proper hygiene of the suturing area after surgery. Failure to follow the rules for caring for the seams can cause discomfort, burning sensation, pulling pain, and cause complications.

Unpleasant sensations during active movements may accompany you for several months after the operation.

The whole process of rehabilitation after mammoplasty with a return to a full, normal lifestyle usually takes about 1 year.

How to relieve pain after mammoplasty?

To relieve pain and prevent inflammation in the postoperative period, painkillers, anti-inflammatory and antibacterial drugs are prescribed. The surgeon will recommend the scheme and duration of the reception.

Prohibited after surgery:

• drinking alcohol – within 2 weeks;
• physical activity, sports – 4-6 months;
• visiting saunas and baths – 2 months;
• sunburn, sunbathing – 4-6 months;

Recommendations on the regimen:

• sleep on the back for the first 2 weeks after the intervention, then it is allowed to sleep on the side. You can sleep on your stomach no earlier than a month later, if there are no discomfort;
• physical activity, even minor, should be limited for 2 months. In the first week, active hand movements should also be excluded so as not to provoke displacement of the implants;
• Compression underwear around the clock for 1 month. A few days after the aesthetic surgery, the doctor will allow you to take a shower and remove the compression underwear for 1-2 hours. Wearing special underwear not only fixes the implants, but also reduces postoperative swelling. After a month, the doctor will recommend wearing compression underwear at night for another 1 month.

The final result of the operation will depend not only on the actions of the surgeon, but also on the implementation of all recommendations in the postoperative period by the patient herself. Physical calmness and psychological comfort are essential attributes of a painless and quick rehabilitation period.

If you want to consult on mammoplasty in our clinic, write to Dr.