Numerous side effects of breast reconstruction
The tightness in your arm pit may be related to lymph node dissection. This may cause a significant amount of scarring and may need extensive physical therapy. Breast reconstruction in and of itself usually does not affect the axillary region. If you had radiation in addition to surgical extirpation, this can cuase tightness in the chest wall. THe fact that the implants feel soft and are moving suggest you do not have capsular contracture. However, you can still have a sensation of tightness due to capsule formation on the ribs. A complete analysis requires a complete examination in person.
You can almost certainly be made better with revisional surgery.
No idea what the problem is without seeing you. The bad news is it will not get better by itself. The good news is it can probably be improved with surgery. In New York, we do a fair number of revision breast reconstruction surgery, and usually the patients end up happy.
Hard to answer your question without photos
Including some photos would allow us to tell you much more about what might be going on and what options you have. If you could re-submitt your questions with photos some much more specific nswers might come your way.
Algorithm for breast reconstruction revision
A clinical exam will determine the aetiology of your symptoms. The algorithm is:
1. Rule out breast capsule issues. If you have tight capsule, you might need a capsule removal or release. The tight capsule will make you uncomfortable,will distort the breast and will make you asymmetric.
2. Check implant integrity.
3. Check integrity of the Infra mammary fold.
4. Check the need for adding tissues e.g fat grafting, alloderm
The next step is to make a surgical plan based on the anatomy and your expectations.
Best of luck!
Muscle repair after breast reconstruction is rarely the issue
Breast reconstruction can get complicated. How tissues will respond when treated by radiation, chemotherapy and tissue expansion can be variable. With this being said, it is unlikely that the muscle is the crux of the problem. Have your surgeon take a look and offer some advice as to how you might proceed.
Sounds like a revision procedure with Alloderm may help
Alloderm is a cadaveric (human) piece of skin that has been treated of all of its cells, leaving a matrix of collagen. It's used routinely in immediate breast reconstruction, but can also be used in revision procedures. The surgeon can use the Alloderm to create a sling for the implant to sit in, and can also position the Alloderm to correct and control your breast fold as well as the lateral (armpit side) of the breast mound.
You need to see a surgeon with a lot of experience with breast reconstruction because this procedure can be a little involved. With the right surgeon and surgical plan, you should experience an improvement in your appearance.
Muscle repair may not be the issue
Adverse results from breast reconstruction surgery can vary widely in their causes. It is impossible to appreciate your specific condition from just a description of your symptoms. A visit to your plastic surgeon would help to specifically identify your needs. Good luck!
Yo may need muscle sling repair
Generally the pectoralis muscle which is most likely the muscle which has been used is not of tremendous functional significance.
Having said that, it does not negate your comments.
There are no widely accepted methods of repairing the muscle. So this is not likely to be an option.
It basically sounds as if you are "bottoming out" this may require reconstruction of the muscle sling which is commonly performed with an allograft. It is also very likely that you may benefit from a smaller or textured implant to keep it from moving.
Breast reconstruction can be done in so many ways that I'm having a hard time picturing what surgery was done. Was it immediate reconstruction with implants, tissue expanders, latissimus muscle, another flap? What exactly was the surgery?
The skin will continue to stretch if there is no underlying support for the implant, ie pectoralis muscle and Alloderm or a flap. The pain issue is difficult to assess but if the implant was covered completely with muscle, using the pec and the serratus, this has been known to cause pain.
Write back with more information and we'll be better able to help.