Abnormal pain after breast augmentation

Abnormal pain or hypersensitivity after breast augmentation can be a frustrating sequel of breast surgery with implants. Of the posts I have written, the only one that gets almost daily feedback is “Pain after Cosmetic Breast Augmentation.”

Unfortunately, many breast augmentation patients continue to have pain months after surgery. Some aches are related to muscle stretching and others to nerves.

Many questions are related to symptoms associated with nerve damage or nerve stretching that lead to dysesthesias, an abnormal or painful sensation brought on by normal stimuli. This involves:

  1. numbness, especially in the central part of the breast
  2. a burning or “electrical shock” sensation in the breast and nipple
  3. pain in the breast; generalized ache or sharp pains
  4. hypersensitivity of the breast and nipple; at times patient cannot tolerate clothing touching the skin!

Causes of nerve damage during breast augmentation

Breast enlargement surgery involves placing a saline or silicone implant under chest skin/muscle. The implants will stretch the skin/muscle as well as blood vessels and nerves.

When an implant is placed over the muscle, nerves are at a higher risk of injury.

Whether cut or stretched, nerves will stop functioning correctly after breast augmentation. Normal sensations may not be transmitted (numbness) or may be transmitted in a faulty manner, causing abnormal breast pain.

Healing of breast nerves

Nerves heal through a slow and fascinating process.

Each nerve is a bundle of many different nerve cells. Each nerve cell has its own specific sheath called a myelin sheath that protects the nerve. Think of it like the plastic (sheath) wrapped around the metal part (nerve) of an electrical cord. When a nerve gets damaged, there may be a total loss of it or just bruising. A bruise will be repaired within a few weeks, but if there is a break in a nerve due to stretching, the myelin sheath will remain intact but the nerve will have to grow back  at a rate of 1 inch per month, all the way from the spine down the sheath. This process can take up to two years and is dependent on how far away the end point of the nerve is from the spine. Cut nerves in your foot and it takes years for sensation to come back, if it ever does. For your breast area, if a nerve is cut or dies, it will take about 1 year for sensation to return to normal.

Abnormal breast pain sensations

As nerves grow back, they can sometimes:

  • take a wrong turn
  • get jumbled up
  • grow to the correct area but not know what to do and transmit the simplest sensation they can, which is pain!

When a nerve grows back in a jumbled-up manner, it causes a neuroma, a knot of nerves that is exquisitely painful and requires surgery for removal.

More commonly, new raw nerve endings arrive at the right place but transmit the wrong sensations, such as pain, burning, electric shocks and hypersensitivity. These nerves need to be taught how to do their job, a process called desensitization. In the next two posts I’ll talk about what you can do to decrease abnormal pain after breast augmentation.

Morad Tavallali, M.D., FACS