Hormonal breast pain - should I be concerned about my upcoming implants surgery?

Question

I am 48 and likely perimenopausa. I have fairly significant hormonal breast pain 2.5 to 3 weeks out of the month. I am scheduled to get implants in. Few days and I am concerned 1. Whether I should be getting them during the "flare ups" (although they aren't always easy to predict timing wise) and 2. If there is anything detrimental to having implants given that I deal with this Or if it will make it worse

Daniel Barrett, MD · Answer

Dear Optimistic573969,
it is hard to tell for sure without an examination. If you have any concerns, you should discuss them with your surgeon. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

The hormonal breast pain that you experience will not impact your ability to proceed with surgery nor will it impact your results.  I encourage you to discuss your concerns with your surgeon so that you are comfortable and confident as you prepare for surgery.

Connie Hiers, MD, FACS · Answer

Surgery is stress and it might stop of decrease your cycle which can decrease the hormonal tenderness. However, surgery is also painful and you will be given pain medication. You should be fine.

Mats Hagstrom, MD (license on probation) · Answer

In many ways, it’s better for patients to recognize that breast pain is common and normal in many women before getting implant augmentation.
Breast pain is a really common disorder.
Lots of women develop breast pain after having implants and make an association.
Implants typically do not cause pain unless someone has a complication like a capsular contraction.
Properly done breast augmentation surgery actually doesn’t have all that much to do with your breasts at all other than how they look. 
That may sound funny, but in reality, most implant augmentation surgery places the implant on the rib cage behind your pectoralis muscle and simply pushes the muscle forward, making the breast look bigger.
Implants don’t actually make your breast bigger at all.
They create an illusion of a larger breast by pushing the pectoralis muscle forward.
The implant itself is between your ribs and the pectoralis muscle.
 If you think of breast augmentation this way, you’ll recognize that the implant really doesn’t have much to do with breast tissue at all.
If the implant is placed above the muscle, then the situation is more or less the same. The implant now sits below your breast, pushing it forward.
Most plastic surgeons who have extensive breast surgery practices use sub-pectoral placement because of its advantages.
The biggest advantage to placing the implant above, the muscle is that it’s technically much easier.
It’s unlikely that having a breast augmentation will change your hormonal breast pain.
Most patients will have a very slight decrease in nipple sensation from breast augmentation.
This is typically directly related to the size of implant used.
It’s usually not bothering some, but patient often appreciate knowing about it ahead of time.
 There are three variables that determine breast augmentation outcomes.
The first variable is patient candidacy.
Not everybody is an ideal candidate for breast augmentation surgery.
Understanding your own candidacy will help increase long-term patient satisfaction because patient will understand what the results are likely to look like.
Variables that alter candidacy include breast asymmetry, breast, droopiness, Breast position on the chest wall, breast, divergence, etc. 
The second variable is implants selection in regards to size, shape and type.
Each plastic surgeon will have their own way of guiding patients through the implant selection process.
Some providers do this much better than others.
Some providers ask patients to make the final selection of implants and other providers will make the selection based on patient input.
 My personal preference is to work with before and after pictures of previous patients who had very similar body characteristics.
Once I have images of what the patient considers ideal outcomes I bring those pictures with me to the operating room.
During surgery, I use temporary sizers to determine what size implant will create The outcome consistent with what the patient’s desires are.
I typically have a full selection of implants available to me during surgery.
I find this to be the most accurate way of selecting implants.
Each provider will have their own way of doing this.
 The last variable is placing the implant in the correct an atomic location.
In other words, it is provider selection.
Delivering consistent quality breast augmentation results is not as easy or straightforward as it may seem.
Indications for revision surgery is often related to in incorrect Anatomic placement of the implant.
This can lead to situations like implants sitting high or implants bottom out.
Opening the IMF (infra mammary fold) to accommodate larger implants will increase the chance of the implants bottoming out down the road requiring difficult revision surgery.
to find the best provider, I suggest patients have multiple in person consultations with plastic surgeons in their community.
I generally recommend people avoid virtual consultations whenever possible.
I also generally recommend avoiding people travel long distances for elective surgical procedures.
get set of standard breast pictures of yourself.
This is best done having someone else take the pictures or use the timer on your camera.
Look at how plastic surgeons take before and after pictures to get an idea.
Bring pictures of your breast with you to use as reference during each consultation.
Don’t rely on your memory or looking in the mirror when reviewing before and after pictures.
Having a clear understanding of what your breasts look like when reviewing before and after pictures is key.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar breast or body characteristics to your own.
Being shown a handful of pre-selected images representing the results of a providers career may be insufficient to get a clear understanding of what results look like in the hands of each provider.
 It’s very important that the provider shows you images of previous patients who have very similar breast characteristics.
Look very carefully at the nipple relationship to the IMF.
Understand if you have breast ptosis or breast Pseudoptosis. 
An experience provider should have no difficulty showing you an impressive collection of before, and after pictures.
It may not be necessary to see all of them, but an experience provider should have what looks like an endless collection of before, and after pictures.
Haily experience surgeons should have access to hundreds or preferably thousands of before and after pictures to choose from.
Ask each provider how they guide the patient through the implant selection process.
Pay attention to who is detail oriented and gives you a thorough explanation.
Quality work takes time and quality work includes not only surgery but the consultation process.
Ask each provider what the most common indication for revision surgery is, what their revision rate is and what their revision policy is.
All plastic surgeons do revision and breast augmentation surgery is no exception.
 Low revision rate is not necessarily ideal.
Plastic surgeons who want patients to have the best outcome should have a relatively low threshold for doing revisions.
At the same time those who have the greatest skill are going to have predictively better outcomes.
There’s no correct number of consultations needed to find the right provider.
The more consultations you scheduled the more likely you are to find the better provider for your needs.
Provider selection is the most important variable and the variable patients have the most control over.
For breast augmentation surgery having 3 to 5 consultations is probably sufficient.
It’s never wrong to have more consultations.
The biggest mistake I see patients make is having only one consultation and then scheduling surgery.
The second biggest mistake I see patients make is assuming that being born certified in plastic surgery with a few years of experience and some good reviews means that the provider has mastered most plastic surgical procedures.
This is simply not true.
We’re making a list of potential providers look at who does most of the breast cancer reconstruction in your community.
These plastic surgeons are usually some of them more competent breast surgery providers.
Best,
Mats Hagstrom MD

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