- 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 anesthesia, 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.