Pain in reconstructed breast

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1openheart
1openheart Member Posts: 765
edited October 2021 in Living Without Reconstruction After a Mastectomy

Hello everyone. It has been a long time since I have posted, but I am hoping to gain some insight into what is going on with my reconstructed breast. I also posted this in the Pain thread, because I was not sure where to place my question. I had my mastectomy and direct to implant reconstruction in June of 2011. So I am coming up on 10 years with my implant. It is a smooth, round, hight profile Mentor silicon implant. Over the past year, I have notice an off and on dull, achey pain that starts at my armpit and goes around the top of the breast and around. I mentioned it to the tech when I had my annual mammogram in November and they did not see anything of concern. I also mentioned it to my oncologist when I saw her for my annual visit. Again, nothing that was concerning to her. I did not go see my surgeon because of Covid concerns and the discomfort was intermittent. Well, it is no longer intermittent. For the past 3 weeks or so the pain has become much worse. The dull ache is now accompanied by a burning sensation in the entire breast and down my arm and up into my neck. There has been a ripple on the inner upper quadrant for a long time. And the breast doesn't feel particularly firmer to me. It may be riding higher on my chest than before, but it is hard to know for sure. The natural breast has defiantly drooped some so it is hard to compare the two. I have an appointment with my surgeon next week and I am confident that the will order an MRI to check for rupture or CC. So my question for you wonderful, helpful ladies is, does my description of the symptoms sound like anything that you experienced and what was your diagnosis? Thank you in advance for reading my post and sharing your experiences.

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  • LivinLife
    LivinLife Member Posts: 1,332
    edited April 2021

    Welcome 1openheart though sorry you need to be here (again).... I'm glad you have an appointment with the surgeon right around the corner! As you said I'm sure they will evaluate this further MRI or otherwise.... I have not experienced this... I had pain in the area of my DCIS though cannot remember if I had that in the same way prior to diagnosis or if it was nerves soon after diagnosis... I basically just want to send support and wish you well with your appointment next week. Hopefully someone else will come along that may offer more information or experience.....

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  • 1openheart
    1openheart Member Posts: 765
    edited April 2021

    Thank you, LivinLife! I so appreciate your note. Your dx sounds much like mine, although mine was very ER and PR positive. I had multicentric and multifocal DCIS with lots of comedo necrosis. I had a fair amount of pain in the first year after my surgery. I had a lot of nerve regeneration pain and some cording that developed in my abdomen. I was very lucky to have a wonderful myofascial release PT practice near my and they helped me immensely. I hope that I get some answers next week, but I don't know how long it will take to schedule the MRI. Honestly, I'm not sure what I want to hear. I'm not too worried that this is a cancer reoccurrence. But if it is CC or a rupture, then I will need more surgery. I guess that the best outcome is that it is a pulled muscle.....but weird that I have felt the pain off and on for so long. Thank you again for taking the time to reach out. I hope that I will hear from others that have felt the same kind of discomfort and pain and can share some of their insights.

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  • 1openheart
    1openheart Member Posts: 765
    edited April 2021

    Quick update....I had a good visit with my surgeon today. He agrees that CC is unlikely. He thinks it is more likely to be a rupture or tear in the implant, or possibly the implant has shifted and is now impinging on a nerve or surrounding tissues. He has ordered a MRI. I am waiting for the scheduler to call me and hopefully I can get it scheduled soon and then hopefully have some answers. I would still love to hear from anyone who has experience with what a rupture of a silicon implant feels like. Thank you and be well.

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  • LivinLife
    LivinLife Member Posts: 1,332
    edited April 2021

    Wow not that a tear sounds great either though this is one for perspective-taking, right? I hope it is something "that simple" for you! Please let us know after your MRI, OK? Best!!

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited April 2021

    1openheart - I asked my PS about having a MRI at my annual appt with her in Nov 2019 because I had been experiencing some intermittent discomfort where I had previously had a large suture granuloma, which was also the site of my tumor - basically at the outside edge of the breast where an underwire in a bra would end, directly below the axilla. I also have textured implants and wanted them looked at, particularly in light of this sporadic discomfort. For a number of reasons, mostly having to do with some weird lab results that I needed to clarify and nail down cause for, I delayed the MRI. I saw my PS again in Dec 2020 and this time ordered the MRI, done in late Dec right after Christmas. Everything is fine in terms of anything that would be linked to textured implants, no suture granuloma, no evidence of a malignancy, but surprise - ruptured implant on the right. I will say that it doesn't bother me all the time, but when I notice it what I do feel is a tightening feeling, like a muscle seizing, but it is not sharp or severe. I have a heightened awareness of that implant, if that makes sense. Had it been worse I never would have delayed the MRI, and it has not worsened since I initially discussed this with my PS. I will be having another surgery to replace the right ruptured implant with a smooth, I will also replace the left to a smooth because I am already there under anesthesia and don't see why not. My consult for the surgery is in two and a half weeks. In between the MRI and now I have gotten both injections of Pfizer vaccine so I am feeling a bit better about surgery. If I can answer any specific question please don't hesitate.

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  • 1openheart
    1openheart Member Posts: 765
    edited April 2021

    Will do! Thank you! I got the robocall to schedule at 7:05 and they close at 7:00. So I'll get it scheduled tomorrow. Hopefully I don't have to wait too long for an opening. Take care!


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  • 1openheart
    1openheart Member Posts: 765
    edited April 2021

    Hi SpecialK...I have read about silent ruptures. Sounds like what you are experiencing. This hurts too much to be silent if it is indeed a rupture. I'm glad that you are getting taken care of and it is probably best to go ahead and replace those textured implants while you are at it. We have also had both our our vaccines and I feel better about getting this taken care of if I need to have surgery. Thank you for taking the time to reach out. You know, I think I remember chatting with you when I first was dx and new to these boards. I'll update when I know more. Take care.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited April 2021

    Def keep me posted, and yes, I remember you, I recognized your heart shaped cloud! So sorry you are having this concern and experiencing pain, so not fun, but hoping you get answers asap and there is a fix right around the corner for you.

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  • 1openheart
    1openheart Member Posts: 765
    edited April 2021

    Well, I can't get an appointment for nearly 2 weeks, but I am going to call everyday and check for cancellations. Looks like my surgeon ordered the MRI with contrast. I don't need contrast to evaluate the implant, but we discussed whether or not it made sense to go ahead and do one with contrast since I will already be in the machine and I do still have one breast that has been pretty dense in the past. So, it will mean a few more uncomfortable minutes in that noisy machine while laying on my face, but hopefully it will give me an answer to what is causing the pain in my foob and give me a clean bill of health for my boob. Take good care and be well.

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  • dreaming
    dreaming Member Posts: 473
    edited April 2021

    This April is 30 years from diagnosis, and still I get sometimes a sharp pain behind my tram flap reconstructed breast.

    My doctors tell me nerves growing that takes a long time.

    It is a weird pain since my breast is numb.

    It helps a warm pad or bottle, also use the pillow for under the arm.

    Make sure to have a close follow up, do the exercises for life, I forgot to after years and ended with a frozen shoulder,had to have 1 year of painful PT to regain use of the arm on the side of my surgery.

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  • 1openheart
    1openheart Member Posts: 765
    edited April 2021
    Hi all. I had my MRI early last week and I finally heard from my surgeon last night. I also went and picked up the MRI report yesterday from the imaging center because I was getting impatient waiting for him to call me. Good news....no signs of any cancer in either the reconstructed breast or my remaining natural breast. I wasn't expecting them to find any, but it is always nice to have a clean report. There is also no mention of an implant rupture or any fluid in or around the capsule or implant. So, all good news.

    So this is what they did find: There is an area of inflammatory reaction involving the implant capsule in the superior medial area and clinical correlation is requested. That is exactly where most of the burning pain is located. There is also a blooming artifact within the inferior axilla felt to be related to some form of metal clip or calcifications. I also have pain there. I don't recall having any kind of biopsy clip placed there, but I wonder if it could be from the sentinel node biopsy? So my general surgeon wants me to see a plastic surgeon. The one who did my reconstruction is no longer doing reconstruction so I need to see someone new. But my original plastic has agreed to see me for a consult and hopefully he can give me some insight about how best to move forward. My current plastic's nurse called me back today and said he wanted me to take Singulair until I see him. He still thinks that I may have some contracture. I told his nurse that my foob is still soft and that I have been on Singulair for several years for my asthma. Could the Singulair be enough to keep the implant soft but maybe not enough to prevent inflammation and pain? My pain has been pretty bad this week. I was out and about quite a bit yesterday and I find that driving really causes a lot of pain. I think that driving causes me to activate my arm muscles which activates my chest muscles and moves my implant around toward my armpit. I had to ice my chest last night. Well, that's all I know right now. I really appreciate any and all feedback and, as always, I thank you all for your grace and support.
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  • SpecialK
    SpecialK Member Posts: 16,486
    edited April 2021

    Five years ago I had what should have been a routine PET that my MO ordered based on my BCI results that showed no benefit for extending aromatase inhibitors past that point. The thought was that maybe it hadn't been protecting me very well in the first five years either, so the PET was to double check for anything lurking. It came back bi-laterally abnormal across the chest in multiple locations. I was already scheduled for surgery the following week with my plastic surgeon but she balked at keeping that date if there was any suspicion of malignancy. I could not have an MRI because I had one expander - this surgery was to exchange the expander and downsize the other implant to match. The PET results were sent to my breast surgeon who reviewed and said he didn't think there was malignancy and he instructed the PS to biopsy in all the locations that showed abnormality. I had the surgery, the above mentioned suture granuloma was revealed at the site of my original tumor as well as four types of inflammatory process. I definitely had pain, partly because of the size of the suture granuloma pushing my already pretty large implant on the right, but also because the whole chest was inflamed. After surgery it all calmed down and the pain subsided. I can't speak to the contracture possibility as I have not experienced that, but I am hopeful that there is a fix for the area of inflammation. Also, I have an axilla full of surgical clips as a result of ALND, and you may well have one there from your SNB. I wonder if the clip can be pinpointed and removed?

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  • 1openheart
    1openheart Member Posts: 765
    edited April 2021
    Hi SpecialK...geez, what a mess for you and your surgeons to work around. I'm glad that you eventually got some relief from your pain. My MRI report did not mention any signs of granulomas or fluid buildup. I, too, am hopeful for a fix. I would, of course, prefer to avoid surgery if possible and maybe have some PT or other non invasive treatment. We'll see. So far, I have called three plastic surgeons that have been recommended to me and that are on my insurance, and all are booking way out into the summer. Maybe my general or old plastic can call in a favor and get me in sooner. Thank you again for responding. Take care.
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  • 1openheart
    1openheart Member Posts: 765
    edited May 2021

    Wanted to give an update. I saw my plastic surgeon from ten years ago today about the pain around my implant and the MRI results. He is confident that I do not have capsular contracture, but he feels like my pectoral muscle is inflamed and has developed some scar tissue which is adhering to my implant capsule. He has recommended physical therapy with ultrasound treatments and he gave my a muscle relaxer to take at night. Hopefully this will do the trick and give me some relief soon.

    Many thanks to those of you who reached out to offer support and share your stories. Take good care. I'll update in a few weeks.

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  • Roth59
    Roth59 Member Posts: 2
    edited October 2021

    To 1openheart (or others with suggestions),

    I hope all is going well for you. I am experiencing probable capsular contracture again on mastectomy side after having open capsulectomy and implant replacements about 2 years ago. It is painful and frustrating to be going through this again with few suggestions/options from my PS. I realize your issue was somewhat different, but the pain from scar tissue is likely quite similar. Just wondering if the PT with Ultrasound, along with muscle relaxants were beneficial for pain reduction.

    Left Mastectomy Surgery 3/01/2018, DCIS, 1.2 cm, Stage 0, Grade 3, 0/3 Sentinel nodes, ER-/PR-; 5/24/2018 Left Reconstruction with Allergan 410FX and Right Augmentation with Allergan 410FM; 11/14/2019 Open Capsulectomy left, Open Capsulotomy right, bilateral implant replacements (round silicone)

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