Hard cleavage & pain tightness almost always, what causes this?

Hello and thank you for your question. Pain after implants can have different causes. "hardness" or a firmness that develops around a breast implant along with pain/discomfort may be indicative of capsular contracture, which is a condition in which the normal scar tissue layer around the implant becomes thicker and starts to "squeeze" around the implant. There are various causes for this, one of which can be an implant rupture. The treatment for this is to remove the affected implant and capsule layer. The next best step is to be examined in person by a board certified plastic surgeon. They may be able to diagnose you clinically based on history and exam, but there may also be a role for imaging studies such as an ultrasound or MRI.

Unfortunately, you have not provided photographs but most likely you have capsular contracture. the body responds to the implant and surrounds it with a capsule that contracts and causes pain. This may be what you are feeling.

Best Wishes,

Gary Horndeski, M.D.

If you are still early in your recovery this is part of the healing process and will improve as swelling resolves and the tissues heal. If you are more than six months out from surgery the symptoms you describe could indicate a capsular contracture. Visit with your surgeon who can evaluate your concerns.

You probably have developed a capsule around your implants. Please go back to your surgeon and be checked. If you have not had a mammogram in a while, please get one.

It’s hard to asses without and exam or pictures.
It sounds like you may have developed a capsular contraction. This is a layer of scar tissue that form as around the implant. It’s normal to form a thin layer of scar tissue around implants called a capsule.
In some circumstances there is increased inflammation causing excessive scar tissue to form. Thick layers of scar tissue trend to shrink or “contract”. When that happens the tightness of the capsule begins to deform the shape of the implant. In the most extreme cases the implant will look and feel like a tennis ball under the skin.
We don’t know why some people form capsulsr contractions but there are a few risk factors. Excess blood from bleeding during or after surgery is one reason for capsular contractions to form. They are more common when the implant is not placed under the pectorals muscle(above the muscle or sub-glandular). A third reason is contamination with a very slow growing bacteria called Staphylococcus Epidermidis. This bacteria does not cause a clinical infection, can not be tested for (with standard tests) and can not be treated with antibiotics.
I suggest you follow up with your plastic surgeon to get evaluated.
There are other reasons women have problems with implants as well so get a proper evaluation.
Best,
Mats Hagström MD