What causes CC to become painful, what's an appropriate pain control?
Doctor Answers 2
There are a couple of options for dealing with the pain of capsule contracture
There are a few things you've mentioned here that warrant a deeper discussion. It sounds like you recently delivered a baby, and that you are still breastfeeding. This is one of the things I have discovered to be associated with the later formation of capsule contracture. I'm not sure I can explain exactly why this happens, but the capsule contracture process is an inflammatory process that can cause pain at times. I think the ultrasound is a good idea because this can show if there is any kind of fluid around the implant. This can be a source of pain, swelling, and tightness in the breast, and if it's present, it will need to be treated. You have not told us whether you have saline or silicone gel implants, or how old the implants are, but I'm going to speculate and say that they aren't any older than about 15 years or so, given that you are still a young mom. Thus, the issue of any "leaking" of implants to me is secondary. If you have saline implants, a leak will deflate the implant, but it will have no effect on your capsule or your overall health. If you have silicone gel implants, again assuming that they are younger than 15 years old or so, the gel used during this time frame is a cohesive gel, meaning it is essentially solid. Thus, not only do these implants not "leak" in the traditional sense, but they will not affect your health. If a silicone gel implant does rupture, it can accelerate a capsule contracture process, but this won't be very easily detected on an ultrasound. I would lay more of the blame for your capsule contracture, if in fact that's what you have, on the breast feeding than the chances of ruptured gel implants. I am assuming that the family doctor has already evaluated you and ruled out the possiblity of primary issues with the lactating breast first, like mastitis, or lactoceles, which can cause pain and firmness of the breast.
If it's concluded that you in fact have capsule contracture, the thing that I would suggest immediately is a trial of Singulair, or montelukast, 10 mg every day for at least 3 months. This is a special type of anti-inflammatory medication which is used primarily for asthma and allergies, but it has been very effective in helping decrease the inflammatory process associated with capsule contracture in the breast. This could very well help control your pain without the need for narcotics, again, if in fact you do have capsule contracture.
While the family doctor can certainly prescribe Singulair, my best advice would be for you to get an evaluation from a board certified plastic surgeon who has lots of experience with breast surgery. We deal with implants and implant related issues everyday, and while the family doctor may be an excellent doctor, she won't have the same experience with this particular issue that a plastic surgeon will. This doesn't obligate you to undergo surgery at this point, if you aren't ready or can't afford it, as most surgeons I know would look at this as a doctor as something that just needs to be treated, and help you with this specific issue, even if you didn't have surgery right now. It gives you the best opportunity for a thorough evaluation and appropriate treatment if the condition winds up being related to your implants. Best of luck, and sorry to hear that you have to be dealing with this stuff, especially when it should be a happy time with your new baby.
It is unlikely you have an 'leak', and if you did have an implant rupture, 99% are contained within the scar capsule. It is safe to breast feed. If you do not have access to high definition ultrasound and a competent technician, you may be better off with an MRI if you really are concerned with implant rupture. Remember, only 6 to 9 % of silicone gel implants are ruptured at 10 years, how old are yours? CC is almost always caused by bacterial contamination of the implant causing biofilm formation on the surface. There is no need to worry, there is no emergency. Best of luck!