Logan Steele
Breast implants are a crucial component of plastic surgeons' cosmetic and reconstructive toolkits worldwide. While breast implant surgery typically improves patient breast satisfaction and health-related quality of life, it is linked to long-term local problems like capsular contracture, breast discomfort, and chest pain. Chest pain following breast implant surgery can stem from a variety of factors, including surgical recovery, capsular contracture, and implant placement. The placement of implants in relation to the chest muscle is an important consideration, as it can impact the appearance and potential for distortion of the breasts. Implants placed over the muscle may be preferable in some cases to avoid distortion during muscle contraction.
| Characteristics | Values |
|---|---|
| Can implants in the top of the muscle cause chest pain? | Yes, atypical chest pain is one of the reasons patients with breast implants seek consultations. |
| How common is chest pain after breast implants? | A study of 828 cases of breast implant removal was published in the South Med J. in 2014. |
| What causes chest pain after breast implants? | Chest pain can be caused by capsular contracture, which is the formation of scar tissue around the breast implants. Other causes include implant rupture, herniation, and inflammation. |
| How soon after breast implant surgery does chest pain occur? | Chest pain can develop slowly after breast augmentation, and it can last from 15 minutes to 4 days. |
| What are the symptoms associated with chest pain and breast implants? | Symptoms associated with chest pain and breast implants include nausea, vomiting, diaphoresis, dyspnea, and palpitations. |
| What are the risk factors for chest pain after breast implants? | Older age is a significant predictor of an increased risk of complications after breast implantation. Other risk factors include the size of the implants and the amount of natural breast tissue. |
| How is chest pain after breast implants treated? | Treatment options include implant removal, implant replacement, and surgical procedures such as prepectoral revision and explant and autologous reconstruction. |
| How can chest pain after breast implants be prevented? | Proper implant coverage and placement are important for preventing chest pain and other complications. |
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What You'll Learn
Capsular contracture
The formation of scar tissue, or a "capsule", around an implant is a normal part of the body's healing process. This capsule usually helps to keep the implant in place and prevent slippage. However, in some cases, the capsule can contract and harden around the implant, leading to capsular contracture.
The severity of capsular contracture can vary and is typically graded on a scale from 1 to 4. Grade 1 capsular contracture is asymptomatic, with the breast feeling and looking normal. Grade 2 may present with minor cosmetic symptoms, such as slight firmness but a normal appearance. Grade 3 capsular contracture is characterised by more significant firmness and an abnormal appearance, such as overly round breasts or misshapen nipples. Grade 4 is the most severe form, with the breasts becoming hard, misshapen, and painful.
The exact cause of capsular contracture is unknown, but several factors may contribute to its development. These include bacterial contamination, the body's immune response, genetics, and the type of implant used. Ruptured implants are a common cause of late-onset capsular contracture. While capsular contracture is not typically dangerous to the patient's health, it can be a concerning complication as it may alter the appearance of the breasts.
Treatment options for capsular contracture range from medication to surgery, depending on the severity of the condition. Preventative measures during surgery, such as ensuring sterility and using antimicrobial solutions, can help reduce the risk of capsular contracture. Additionally, regular breast self-massage after surgery may also help to maintain the softness of the capsule and potentially reduce the risk of capsular contracture.
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Breast implant herniation
Breast implants are linked to long-term local problems like capsular contracture and breast discomfort. Chest pain is one of the reasons patients with breast implants seek consultations. In some cases, chest pain is unrelated to physical exertion and can last from 15 minutes to 4 days. The pain can be described as a "pressing" type of pain or a "stabbing" pain with radiation to the shoulders, left arm, and jaw.
Breast herniation can be fixed by repairing the capsule rent through a procedure called capsulorrhaphy, which involves sewing up the capsule deformity using sutures. If the remainder of the capsule is thickened and causing further deformities, then the entire capsule may need to be removed. If removal of the capsule may compromise the overlying skin, a breast lift may also be performed to move the entire breast mound complex to an unoperated region of the breast.
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Implant placement
There are two options for implant placement: over the muscle (subglandular placement) and under the muscle. The former is generally recommended for women with some natural breast tissue as it provides cover and support to the implant. This method is also a simpler procedure with a faster recovery and less postoperative discomfort as the chest muscles are not altered.
However, placing the implants underneath the muscle may cause less postoperative discomfort in subglandular implant placement. Nevertheless, this method is more complex and has a higher risk of developing capsular contracture, which can lead to constant pain and cause distortion to the shape of the breasts. It can also cause animation deformity, which is a distortion in the implants when contracting the chest muscle.
If the natural breasts have shrunk due to age and/or breastfeeding and are now below the chest muscles, placing the implants below the muscle is generally not recommended as it could result in the implants appearing unusually over the chest, and possibly disfigured. In this case, placing the implants above the muscle is usually recommended.
There are also no health risks associated with the temporary flattening of implants when the pectoral muscle contracts, but this may be a concern for athletes and bodybuilders.
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Post-operative recovery
While I could not find specific information on post-operative recovery for implants on top of the muscle, here is some general information on post-operative recovery for breast implants.
After breast augmentation surgery, a long-lasting local anesthetic will be placed around the implant to minimize discomfort. You can expect to be sore and stiff for several days. You will have three prescriptions to minimize your discomfort: a pain medication, a muscle relaxer, and an anti-inflammatory. You will need to take it easy for several days to optimize your recovery and allow yourself time to heal. Most patients use the narcotic pain medication for the first 3 days after surgery. You will not be able to drive as long as you are on pain medication or a muscle relaxer. The muscle relaxers may be needed longer at night if the chest muscle(s) remain tight. The soreness usually lasts about a week. Diminished sensation in your breast skin and/or nipple may also occur during this time and is normal.
You will be able to remove your dressings and shower 48 hours after surgery. Steristrips directly on your skin incisions will remain in place until your first post-operative appointment. Do not submerge your incisions in water for 3 weeks after surgery. You can go back to work within 5 days, and your implants will continue to settle for the first 6 weeks. Patience is a must, as it takes time for the muscles and skin to adjust to your new breast size. You should refrain from any strenuous activity or heavy lifting for 2-3 weeks following surgery. You may return to light exercise around 10-14 days after surgery, depending on your progress. You should avoid any twisting, weightlifting, or high-impact exercises for at least 3 weeks. The positions and motions of yoga, Pilates, tennis, golf, and aerobics, and the pressure of push-ups or bench pressing, can cause injury to the muscles and tissues that are healing and adjusting to support your breast implants.
Within a few weeks, you will be fully recovered, but your breast shape and scars will continue to refine over the next several months. It can take up to 8 weeks for the swelling to completely subside. It can take 3-6 months for the breast muscles to completely relax and stretch out, which allows the implants to come forward. Chest muscles following surgery are tight, causing them to push the implants into the ribs. This can make the breasts appear flat and wide. Different patients have varying degrees of tightness based on muscle mass and genetics. Over time, the muscles relax, and the implants will come forward and feel softer. Nerves in the breast area also take several months to heal. As they do, increased or decreased sensation in the nipple will normalize.
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Distortion and discomfort
Breast implants are linked to long-term local problems like capsular contracture and breast discomfort. Chest pain is one of the reasons patients with breast implants seek consultations, and this pain is not typically attributable to cardiovascular reasons.
Capsular contracture is the formation of scar tissue around the breast implants. It can lead to a painful or tight feeling in the breast, new onset breast tingling, or the breast becoming misshapen. It can also cause distortion to the shape of the breasts and make them appear higher in the chest. The four levels of capsular contracture are:
- Grade I: The breast is soft and looks natural.
- Grade II: The breast is slightly firm, but looks normal.
- Grade III: The breast is firm and looks abnormal.
- Grade IV: The breast is hard, painful, and looks abnormal.
The formation of scar tissue can also lead to chest tightness and discomfort. In addition, the implant can temporarily flatten when the pectoral muscle contracts, changing the shape and appearance of the breast for as long as the muscles contract. This can be a concern for athletes and bodybuilders, who may choose to remedy this through surgery or by wearing a padded sports bra or baggier workout shirt.
Implants placed over the chest muscle are a simpler procedure with a faster recovery and less postoperative discomfort. This is because the chest muscles are not altered during the surgery, and there is no chance of the implants distorting when the chest muscles are flexed.
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Frequently asked questions
Yes, implants on top of the muscle can cause chest pain. While chest pain is not usually attributable to cardiovascular reasons, it can be caused by capsular contracture, which is the formation of scar tissue around the breast implants. Other causes of chest pain relating to implants include implant rupture, leakage, and infection.
Capsular contracture is the formation of scar tissue around breast implants. It can lead to constant pain and distortion of the shape of the breasts. Warning signs include deformed, misshapen, and painful breasts, or breasts that are firmer than when first implanted.
It is important to seek medical advice if you are experiencing chest pain after getting implants. A doctor will be able to assess whether the pain is cardiac or non-cardiac in nature.
