4 weeks after en bloc implant removal pain/very sensitive breast. Is something wrong? Is this nerve damage?

Thank you for your question and congratulations on your surgery!  After any breast procedure the nerves of the skin are stretched as a result of swelling.  This stretching irritates the nerves which can cause a number of different nipple and breast skin sensations including increased/decreased sensitivity or a burning/sunburnt feeling.  These normally resolve spontaneously given enough time. Hang in there and be sure to mention these issues to your surgeon during your post-operative appointments.

From your description it sounds as if you are experiencing hypersensitivity of the nerves.  This can occur after surgery but typically improves as swelling resolves and tissues heal.  If it persists or worsens, contact your surgeon for an examination.

I am sorry to hear you are experiencing this. Often, this type of pain that you describe that happens in a delayed fashion after surgery is some hypersensitivity from your skin and internal nerves growing back and branching - this can lead to different sensations for different people, but to some like yourself, it is a lot more bothersome. I would bring this up with your surgeon - there are some measures that can help like keeping your sensitive areas covered with something soft like a cotton shirt, or doing very light massage. Fortunately, for the majority of people, this feeling will go away. While you are having this pain it would be best to allow your body to recover before undergoing further surgery, especially if you are planning on putting an implant back in.