What can be done about scar tissue causing pain?
How to Fix Pain from Scar Tissue After Breast Reconstruction?
Doctor Answers 7
Scar tissue causing pain
Scar tissue can be due to many different causes depending on the type of breast reconstruction. For example, if you have pain from scar tissue stemming from capsular contracture after implant-based breast reconstruction, then you may need a complete capsulectomy (removal of the breast capsule) to improve the pain. If you have pain from scar tissue stemming from fat necrosis after autologous tissue breast reconstruction, then the scar tissue may need to be broken up or resected to improve the pain. The most important thing is to see your plastic surgeon to be evaluated for the source of your pain.
A more simple day surgery like "fat grafting" can help with scarring.
Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final time consists of combining any of the above techniques.
I have operated on several patents over the years with tremendous symptoms from implant based reconstruction. Sometimes the pain caused by the capsule around the implants is to much for them to handle. I have removed there devices in certain cases and replaced it with their ow tissue which has resolved their pain in many situations.
It really depends on the cause of your breast pain
Pain that occurs in reconstructed breasts can occur for several reasons. Most commonly, pain can occur in a reconstructed breast that develops capsular contracture. Pain can also occur secondary to scar contracture, especially when there is a small amount of residual breast tissue left in place.Occasionally, the process of tissue expansion can put pressure on the chest wall and cause pain in this manner.
Although operating for breast pain does not always relieve the pain, there are some things that can be done for each of these conditions. Replacing a tissue expander with a softer silicone implant can relieve some pain complaints. Some patients will benefit from placement of Alloderm inbetween the implant and the skin, which serves to make the skin less sensitive in some. However, some reconstructed breast pain and scarring is really bad, and can only be relieved by "bringing in new tissue," such as with a Latissimus dorsi flap.
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Pain can be from many causes
The pain one has after breast reconstruction can be due to contracture of the capsule around a breast implant or from contracture of the overlying tissue. In either one of these cases, the scar tissue would need to be excised and surrounding tissue mobilized to allow more freedom of movement.
The problem can also be due to injury to one of the nerves supplying sensation to the breasts. If the nerve itself has been injured and is regenerating,the pain will be temporary and would eventually resolve. If the nerve is enmeshed in scar tissue, it will have to be dissected out and possibly repositioned so that it is in a healthy bed of tissue. The nerve itself may have to be destroyed causing a loss of sensation to the area that it supplies, but at the same time alleviating the pain.
If the problem can be isolated to a pinpoint area, then injecting with a small amount of local anesthetic and steroid solution may alleviate the condition and give you an idea of the source of the problem.
A difficult problem that requires patience to achieve improvement.
The problem with pain in the breast area after reconstruction is that it can be caused by many different things. Scar tissue is only one of the causes. The other problem is that it is sometimes very hard to relieve. However, with careful evaluation and, sometimes, a little trial and error, relief can generally be provided. What you need is a thorough evaluation by the doctor who did the reconstruction. If you get no answers, then you need to see an experienced plastic surgeon that has done significant breast reconstruction over many years.
Many possible causes for pain from breast reconstruction
There are many potential causes for the pain. It could be capsular contracture, fibrosis, bony discomfort, axillary scarring, intercostial brachial cutaneous neuropathy, radiation changes, neuromas, etc.
In my experience, the most common cause is a taut axillary scar that often is involved with a caspular contracture.
Conversion of an implant to autologous tissue recosntruction may provide vascularized tissue that prevents recurrent capsular contracture but therre are many other alternatives which are less invasive albeit not as succesful.
Occasionally, I have found that performing a z-plasty on the axillary scar can provide relief of discomfort caused by a tethered scar.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.