Pressure in right breast when bending over - what could cause this?

Question

Had a breast aug just over a year ago, a couple months ago I noticed that when I bend over I get an uncomfortable pressure in my right breast. No pain or discomfort any other time. Have been to a regular doctor and they didn’t feel anything out of rhe ordinary. Unfortunately my surgeon is on the other side of the country from me but thinking about making an appointment with a surgeon here to look at it if needed. Wondering if anyone has heard of this before and what coukd be causing it. Do not have the same feeling on the other side. I go to the gym and lift 5 days a week (heavy lift) and have no pain or discomfort during that, only when I bend over I feel this pressure. 625ccs under the muscle, I am 6’1 and 175lbs

Yasemin Aydinli, MD · Answer

A new one sided pressure that appears only when you bend over, a year after surgery, is most often related to the implant shifting its position or to the muscle and pocket around it. A 625cc implant is a very large volume, even for your height, and when you bend forward the weight shifts and the pocket on that side can feel stretched. Other possibilities are a change in the pocket on the right, a developing capsule, or fluid around the implant, which is uncommon this late but does happen. Since it is only on one side and it is new, I would not ignore it. A breast ultrasound is a simple first step, and an MRI can be added if the findings are unclear. Heavy lifting five days a week puts constant load on a submuscular implant of this size, and reducing chest and pushing exercises for a few weeks is a reasonable test to see if the pressure changes. If imaging shows any change in the implant or pocket, it should be looked at by a plastic surgeon who does breast revision, even if that means a local one rather than your original surgeon.

Daniel Barrett, MD · Answer

Dear Horsegirl77,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mert Demirel, MD · Answer

Pressure that appears only when you bend over, one year after a 625cc implant under the muscle, is most often mechanical. A large implant shifts forward with gravity, and the pectoral muscle and the capsule around it tighten against it. A slightly tighter capsule or different muscle tension on one side can easily make one breast feel this way while the other doesn't.
That said, it's worth checking a few things rather than assuming. Has that breast changed in size, shape or firmness compared with the other? Is there any swelling, heaviness or fluid feeling? Has it become more noticeable recently, or has it been like this since surgery? An early capsular contracture, a fluid collection around the implant (a late seroma), or a change in the implant's position can all start with a vague feeling of pressure before anything is visible.
If the breast is visibly larger, swollen, red or painful, don't wait. That should be examined by your surgeon promptly, and fluid around an implant this long after surgery always needs an ultrasound to find the cause.
If nothing has changed except the sensation, an in-person exam and an ultrasound of both breasts will usually clarify it. Many cases turn out to be benign and need no treatment, and some improve with time as the capsule settles.
Questions to bring to your surgeon: Does the exam show any difference in capsule firmness between the two sides? Is there fluid around the implant on ultrasound? Is the implant smooth or textured? Has its position changed compared with your post-op photos?

Tracey Cook, MD · Answer

Hello! There are several possible explanations for you are experiencing. Because your implants are under the muscle, the sensation could be related to the pectoralis muscle or surrounding scar tissue, particularly given your heavy weightlifting routine. Other possibilities include changes in the implant pocket, implant position, or capsular contracture. However, capsular contracture typically presents with increasing firmness, tightness, or changes in breast shape, which you don't seem to be experiencing.
The fact that you have no discomfort during exercise or normal daily activities is somewhat reassuring. However, the sensation occurring only when bending forward may suggest a positional or mechanical component.I would recommend an in-person examination with a plastic surgeon in your area. The doctor may be able to perform an in-office ultrasound which will be helpful to evaluate the implant and surrounding tissues or further imaging may be useful if warranted.

Miguel Mota, MD · Answer

Hi. This may be the beginnings of capsular contraction or maybe a little fluid build up inside the capsule. Maybe both. This is by no means an emergency but it is something your surgeon should take a look at. You can get on too of it by getting a breast ultrasound or an MRI as soon as possible.

Algie LaBrasca, DO · Answer

New pressure or discomfort that shows up months after augmentation can have a few different causes &mdash; implant position, capsular changes, or even something unrelated to the implant itself. It's worth having your surgeon take a look in person to rule out anything that needs attention, rather than waiting to see if it resolves on its own.

Manuel Diaz, MD · Answer

Hi. Since this is a new, one-sided symptom more than a year after surgery, I would recommend having it evaluated by a plastic surgeon, even though you are not experiencing pain during exercise and your general examination was normal.
With 625 cc implants placed under the muscle, pressure that appears specifically when bending forward could potentially be related to the implant pocket, movement or position of the implant, the surrounding capsule, or the pectoral muscle. Capsular contracture and implant displacement are possibilities, although your symptoms alone are not enough to diagnose either one. 
I would not assume that heavy weightlifting is the cause, but I would mention your training routine during the examination. A local plastic surgeon can examine the implant position, breast softness and pocket, and if there is concern about the silicone implant itself, ultrasound or MRI without contrast may be appropriate. 
The fact that you have no persistent pain, swelling, redness or obvious change in breast shape is reassuring, but I would still have this new sensation checked rather than ignoring it.

Pressure in right breast when bending over - what could cause this?

Answers (7)

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