I am 61 years old, and I had small C cup breast implants placed 3 weeks ago. My nipples and the surrounding area are now very sore and feels a very painful, burning sensation. Are these normal post-procedure? What can I do to ease the condition?
Pain, Swelling, Nipple Sensitivity After Breast Augmentation Surgery
Doctor Answers 101
Breast pain of this type is called a dyesthesia
The medical term for this condition is dyesthesia or hyperesthesia. Typically patients report a deep burn or ache response from only a light touch or stroke. Often clothing or bra can rub against the area causing this discomfort. On rare occasions there can even be disruptions in sleeping.
This condition is often caused by stretching of the nerves, either at the time of surgery or due to the size and location of the implant. A stretched or bruised nerve can often have this problem. Other symptoms related to a bruised nerve can be pins and needles, shooting pains and the deep ache and deep burn sensations. Many times patients describe the pain as coming from under the implant.
The treatment for this type of sensitivity is massage. It is the polar opposite of what you would expect. Massage of the affected area with a moisturizing cream can help to desensitize the area. Many times a patient can localize the exact spot where the pain is coming from.
I have found that a few units of botox in this area will sometimes relieve the pain. Most of the time this hypersensitivity will go away after the nerve gets use to being stretched by the implant.
Hypersensitivity should disappear within 2 months.
In general, we advise our San Francisco area breast augmentation patients to expect some change in sensation immediately after surgery. Many patients report hypersensitivity, and some can't even put a night gown on without feeling "super-sensitive."
These symptoms quickly resolve and usually disappear by 2-3 months after surgery. Burning sensations, "knife-like" sensations, stabbing sensations are also all a normal part of the postoperative course and should disappear in a short time.
Most of our patients have settled and have very little swelling left by 6 weeks after surgery, at which time they can start to truly enjoy the benefits of breast enhancement.
Nipple hypersensitivity could be dysesthesia
Do you know how painful and hypersensitive your leg is when it "falls asleep" and then wakes up? That pins and needles type of feeling? It's even painful to walk on. Sometimes, do you have to stamp your foot to get it to feel normal?
That is one type of dysesthesia that is due to compression of the nerve in your thigh.
Similar problems occur with nerves in your breast that travel to your nipple. When the implant stretches and rests on them, the nerves can be painful and tingling and burning. Generally this is worse for the first 10 days to 3 weeks and then gets better.
When this happens in hypersensitive fingertips after hand surgery, we send patients to physical therapists to perform scar massage.
For you, I would advise moving the implants around to promote softening of the tissues around the implant as well as massaging of the nipples to desensitize them. Of course, please consult with your surgeon.
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Recovery of nipple sensation depends on how the implant was inserted
The U.S. Food and Drug Administration (FDA) has reported that a minority of women who received saline-filled breast implants approved in May 2000 experienced nipple sensation changes after having a breast augmentation. Three years following surgery 5 to 9% of women had intense nipple sensation while 8 to 10% lost nipple sensation. Five years following surgery 10% of women had intense or lost sensation. 
During a breast augmentation, the surgeon may take three common approaches to insert the implant intramamary (in the breast crease), sub areaolar (around the nipple), transaxillary (armpit) often will cut around the edge of the nipple in order to insert the implant. Because this incision is made very close to where the fourth intercostal nerve branch enters the nipple, it is more likely to cause nipple sensation changes than other techniques. However, changes in nipple sensation are possible with any type of incision, but higher with the sub areaolar incision. Nipple sensitivity also seems to be affected more if the implant is placed under the glandular tissue rather than under the muscle tissue.
1. FDA Breast Implant Consumer Handbook 2004: Local Complications and Reoperations. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm064106.htm. Updated May 20, 2009.
Pain, swelling, nipple sensitivity after breast augmentation
Nipple pain after breast augmentation
Hypersensitivity of the nipple and areola after breast implant surgery is normal and is indicative of nerve preservation during your surgery. Once the nerve to the nipple returns to its normal functional state, nipple sensation will be returned to normal. This may take weeks to several months. More worrisome is a loss of nipple sensation.
Some Discomfort & Swelling Is Normal, but...
From this message board, we can't tell much about your individual situation, but many patients have different types of discomfort, pain, and hypersensitivity of their nipples after routine augmentation. The more acute postop pain should subside within a few days. On the other hand, various types of sensitivity are common for weeks or months later, but usually aren't bothersome to most patients.
Swelling of the areola is seen, but less frequently in my experience. If this is accompanied by redness and pain, it could be infection and you should contact your surgeon right away. If not, I suggest calling your surgeon or his/her nurse for information.
We hope you feel better soon.
Swelling and pain after breast augmentation
Nipple Hypersensitivity after breast aug
This is common and will generally resolve over time. It may take up to 6 months before the soreness goes away. You call also try desensitization exercises to help with the hypersensitivity but that my be unnecessary.
Nerve and breast augmentation
Part of the question regarding nipple pain post-operatively should involve a discussion of the approach used for your breast augmentation. Was it through the areola (the dark area near your nipple)? If it wasn't and infection has been ruled out the pain may be transmitted from stretch, or less likely, direct trauma to nerves that provide sensation to the nipple.
If your pain is associated with an incision near your areola then this may be a sign of cutaneous nerve injury which should improve with time as well.
As always, when your post-operative course is a concern you should contact your surgeon and have an examination of the post-op results.
I hope this helps.
Steven Williams, MD