Implant Replacement - What is the Suction Noise and Sensation I Am Feeling?

Question

I had silicone implants put in about 8 mo ago, I replaced my 8 year old saline that had capsule. Yesterday I started to feel like a sucking sensation in my breast as well as a sucking noise when I move a round. I only had the capsule in my left breast, this problem is in my right breast. Any ideas?

Richard H. Tholen, MD, FACS · Answer

In the absence of recent penetrating trauma, at 8 months post-op this is NOT air inside your pocket--any air introduced during surgery was completely absorbed over 7 months ago!

	Your implant sliding against adjacent moist tissues causes a friction rub (sound) that can be felt as well as occasionally heard. This is termed "bourdonnement" and was definitively described in the plastic surgery literature: "Bourdonnement and other benign temporary breast implant sounds", Annals of Plastic Surgery, Vol 43 p589, 1999. Typically this occurs in the immediate post-operative period and resolves without treatment in a few days to weeks.

	When this occurs this long after surgery, the sound is not related to the incompletely-healed and still-inflamed tissues. It may well indicate some new source of inflammation, possibly related to a moderate trauma to the breast tissues, perhaps secondary to bacterial contamination such as from dental work (controversial, but still a real occurrence). The inflammation that causes this sound may also be related to a recent viral illness such as chest cold or influenza.

	A friction rub heard on chest auscultation with a stethescope can be associated with a pulmonary embolus from DVT. Bourdonnement alone without any other symptoms (leg pain, swelling, shortness of breath) is NOT worrisome.  

	Ibuprofen or Celebrex (prescription) anti-inflammatory medications are a good starting point for treatment. If you begin to notice firmness or soreness in the "noisy" breast, this could be an early sign of capsular contracture. See your surgeon for evaluation and consideration of a course of Accolate or Singulair and Vitamin E. Best wishes! Dr. Tholen

Kenneth Hughes, MD · Answer

The nose typically is the result of fluid or air at the interface of the implant shell.  Only an exam can rule something out, but it is probably not a cause for concern if no change in shape or feel of breast is noted.

Adam David Lowenstein, MD, FACS · Answer

As far as you are out from your surgery, any air introduced at the time of surgery is long gone.  As the implants slide along the inside of the pocket, it can occasionally create some sensations and maybe even some noises similar to sucking sounds- this is completely normal.  In fact, it means that the pocket is likely nicely relaxed and non-contracted, so don't worry, and enjoy your new implants!

Richard J. Brown, MD · Answer

I think Dr. Tholen covered it pretty well. I have many patients who have this exact observation. It is rare so far out from your surgery but It could be from fluid in the pocket that oftentimes exists and is benign. We would like to all think that fluid should be gone within a few months, but as many of us as plastic surgeons well know when we go in for revisions on patients years out many of them have some fluid in the pocket. It could simply be fluid. I would go see your original surgeon and at least have it looked at, and if you are in the age group that requires a mammogram, and have not had one recently then it may be a good idea to have one. It will not pick up fluid, but it can give you a clue as to what is going on with the breast tissue. An ultrasound would be more able to show fluid in the pocket.

Jeffrey M. Hartog, DMD, MD · Answer

It is very unusual to hear or feel any type of suction or sloshing eight months after surgery. It's best you see your surgeon for a follow up visit. I can't imagine it's anything to be alarmed with but better safe than sorry.

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