American Society of Plastic Surgeons
For Medical Professionals
Ms Jane
5 years ago

Breast revision pain after 17 weeks

Help. I am still in pain after Silicone revision surgery months ago, with pocket work. Have lateral and sternum pain. Haven't slept more than 4 hours per night since procedure. Surgeon will not address. Says he doesn't know what is wrong. Is it possible internal stitching was too aggressive? What course of action can I take and can you help? I am depressed and in chronic pain.

Procedure: Breast Augmentation
Location: Cameron Park, CA

Replies 6

Gary Culbertson
ASPS Surgeon
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Consider obtaining your operative reports from your Breast Surgery’s. Then, consider seeing a Pain Therapist & another ABMS Plastic Surgeon that specializes in breast augmentation surgery in your area. Send or take your records with you to these visits. It never hurts to get another option from a different contractor. Best,

Gary R Culbertson, MD, FACS

J. Gerald Minniti
ASPS Surgeon

I’m sorry to hear about your persistent discomfort after pocket adjustment surgery almost 4 month ago. Unfortunately, the sutures we use to close the capsule are generally painful, and for most patients a month or more of discomfort is common. I’ve had a few patients complain of this sharp painful feeling along the perimeter of their breasts for at least three months. I would ask your surgeon to refer you to a pain specialist or simply put you on gabapentin for a month. I believe you will get through this soon.

Gregory Dowbak
ASPS Surgeon

Hi Jane! I am very disappointed to hear your surgeon gave up simply because he/she did not have an immediate answer. Your surgeon has a responsibility to work hard and do everything possible to find the answer. This is called “caring” and is the singular most important attribute of a great surgeon. My opinion- 1) its not the sutures, the pain is too diffuse, 2) its not a neuroma, pain would be very localized, 3) until proven otherwise i go with an “immune storm.” These can be difficult to diagnose but the first step is considering this in one’s list of possibilities. Have your family doctors refer you to a rheumatologist or a surgeon who has experience with patients who develope auto-immune response to a triggering antigen. Treatment can be simple from steroids to anti-immune meds such as cyclosporine, 4) PLEASE do not go to pain doctor, they know nothing about breasts and will put you on opioids and get you addicted right away. You are not alone. Similar event happened to me. ❤️

Nelson Castillo

Thank you for sharing your question and I am sorry to hear of your persistent pain. I would continue to work with your surgeon to find a treatment plan moving forward. Pocket work sutures often require deep placement, and some surgeons even anchor them into your rib which can lead to persistent pain for several months. Depending on the quality and location of your discomfort appropriate medications and/or reassurance can be supplied to offer you the best chance at continued improvement.

Thomas Fiala
ASPS Surgeon

Sorry to hear about your post-op problems. I'd certainly get a second opinion, if you feel you aren't getting anywhere with the initial surgeon. My first thought would be to try a prescription of gabapentin, aka "Neurontin". It's worked quite well for breast pain syndromes in our practice, and isn't a narcotic. If you have specific trigger points, these could also be injected with a long-acting local anesthetic, to see if you can get some relief, at least on a short-term basis.

If those methods don't help, you may need to have a revisional surgery, and remove the plication sutures, and even consider removing the implant. Best wishes.

Jon Ver Halen

Hello and thank you for your excellent question. If you are having significant pain and your surgeon is not treating it seriously, it is reasonable to seek a second opinion. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!


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