I had prophylactic bilateral mastectomies 2-22-12 w/expanders and SI (400 or 450 cc).I had exch surg 5-22-12.December 20, 2012, I had revision surgery to move the implants in and up. I have had extreme pain (stabbing) under my right breast along the crease and on the rib since this surgery six weeks ago, and my PS tells me it doesn't make sense.She made the crease by suturing the tissue to the sheath covering the rib and did not use Alloderm, and this is likely the problem.Is this a typical technique?
Pain After Revision to Silicone Implant Surgery After Prophylactic Bilateral Mastectomies?
Doctor Answers 4
Pain after revision of reconstructed breast
I am sorry to hear about your discomfort after this revisionary procedure. Performing a capsulorrhaphy, where your surgeon places sutures to recreate a fold or crease in order to raise or close a breast pocket, is a standard procedure for breast revision. Use of an acellular dermal matrix (e.g., AlloMax, AlloDerm, etc.) may be considered if needed to do this as well. However, it is not always necessary and what you describe is a typical modality to raise the inframammary fold, thus raising the breast implant appropriately.
It is not uncommon to have discomfort in the area, since there are sutures directly around or even onto the rib itself. As the implant settles onto this area, you may experience the pain that you state. This is likely the case in your circumstance, but an evaluation by your plastic surgeon is warranted if it continues, so as to determine the cause. The pain usually subsides over time, and hopefully within the next few weeks - I usually recommend ice packs to the area as needed. If it progresses or worsens, further imaging may be needed or a surgical procedure to explore the area for entrapped nerves or even release these sutures. Thank you for the question! Hope that this helps...good luck!
Pocket can be revised
Trying to recreate the pocket so that the implant is better positioned is a common practice but difficult to guarantee. Often, the capsule can be used to do this and give excellent results without the dermal matrix (such as Alloderm). Whether the surgeon uses native breast capsule or the dermal matrix, you must anchor it to the ribs' covering (perichondrium) or it will simply stretch back out. There are no guarantees with the dermal matrix. Normally the pain you are describing will subside. You might request seeing a physical therapist to help direct your rehab. Best of Luck!
Breast Implant REvision
There are many reasons why you might have pain after the revision. It could be muscular depending on what needed to be done or how long you are from the surgery. You could also have a capsular contracture
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Revision breast surgery and pain
It is certainly possible to have pain after revision breast surgery with alloderm especially where the sutures were placed to secure the alloderm( i.e., chest wall).