Capsular neuroma causing chronic pain in women with breast implants

Abstract

Background

Post-operative breast pain following breast implantation has multiple aetiologies related to capsular formation, muscular pain, and rarely nerve pain. It can be complex in nature with a high morbidity prompting surgeons to readily identify signs and symptoms early to avoid long-term sequelae. The localisation of sensory breast danger zones is central to the understanding of neuropathic pain. We present seven patients with chronic breast pain following aesthetic breast implantation from traumatic capsular neuromas.

Methods

A retrospective review of a single surgeon experience for breast implant-associated neuromas analysing history, diagnostic workup, and management was carried out. Data collected included basic demographics, implant history and symptoms, time to presentation, imaging, and management. All patients underwent baseline bloods, ultrasound (US), and magnetic resonance imaging (MRI).

Results

There were seven patients that presented with chronic breast pain post-breast augmentation. All patients exhibited symptoms of neuropathic pain; however, none showed evidence of intercostal neuromas on breast imaging (ultrasound and MRI). They underwent surgery for implant removal with en bloc capsulectomy. Histopathology of the breast implant capsules showed traumatic neuromas. All patients showed complete resolution of breast pain post-surgery. Identification of neural sensory zones having excluded underlying medical causes should be the initial step of workup, followed by conservative measures including analgesia, scar massage, and desensitisation. In cases that persist without improvement after 3–6 months, implant removal with capsulectomy should be considered.

Conclusions

A sound understanding of sensory innervation of the breast is paramount to the initial surgery, followed by a comprehensive diagnostic workup of chronic breast pain.This case series highlights the importance of assessing and diagnosing post-operative neurogenic chronic breast pain in aesthetic reconstructive patients. The onset and symptoms have great variability, but preceding traumatic events after surgery at some point in time are key to the timeline. Once underlying medical causes have been excluded, comprehensive imaging modalities and conservative therapy should be sought before surgical intervention for removal of breast implants.

Level of evidence: Level IV, Risk/Prognostic; Therapeutic; Diagnostic.