Skin Burning After Breast Augmentation

At least two years after a breast augmentation, you may start having a burning sensation in your breast implants that feels like it is coming from the implant itself. This can be uncomfortable and frustrating. It’s important to understand that this sensation is caused by changes in breast shape due to natural stretching of the skin and fabric around the implant, or swelling of breast tissue near the nipple.”

In this guide, we review the aspects of Skin Burning After Breast Augmentation, skin sensitive to touch after breast augmentation, contraceptive implant burning sensation, and why do my breast implants hurt 2 years later.

Skin Burning After Breast Augmentation

So, you’ve just had breast augmentation surgery. You’re probably excited to see your new, fuller breasts, but the skin burning after breast augmentation surgery may be a little unsettling at first. After all, it’s normal for your new breasts to feel a bit different for awhile—but this doesn’t mean you should worry about the way they look or feel. As long as your incisions are healing well and not causing any pain or discomfort, then everything should be OK! In this article we’ll go over what causes that burning sensation on your chest post-op and how long it may last.

Immediately After Surgery

Immediately After Surgery

After your surgery, you’ll be taken to a recovery room where the staff will monitor your vital signs and make sure that you’re comfortable. You may feel some pain from the incisions in your breasts and chest wall as they heal. Your surgeon will prescribe pain medication if needed, but most patients find that over-the-counter ibuprofen is enough to help manage their discomfort. Swelling and bruising are also common side effects of breast augmentation surgery; this should gradually improve over time as swelling subsides and healing progresses.

Swollen lymph nodes (lymphadenopathy) are another potential complication following breast augmentation surgery; however, this occurs only rarely–about 5% of patients experience it after undergoing breast augmentation procedures with silicone gel implants (the most commonly used type). Swollen lymph nodes are caused by an infection or reaction at one or more sites along the path taken by fluid drainage from within an implant pocket into surrounding tissues; they may also result from inflammation due to trauma during surgery itself rather than being directly related solely  to direct contact between implant materials themselves (such as when doctors inadvertently nick them during removal).

First Day

You may experience some discomfort, swelling and bleeding. You may also have some numbness or pain in your breasts that feels like a pulled muscle. If you have nausea or vomiting, contact your doctor immediately as this could be an indication of infection or inflammation in the breast tissue.

Two Weeks

Two weeks after surgery, your breasts may feel tight and swollen. The skin may be red and bruised. You may also experience some tenderness near your incision sites, as well as warmth in the area of your breasts.

If you’re experiencing any of these symptoms or have other concerns about how you’re healing, contact your surgeon immediately!

One Month

• You’ll be able to shower and wash your hair, but you shouldn’t do so until your surgeon says it’s okay.
• Your breasts will be healing and may feel a little off for the first week or two. They might even look different than they did pre-surgery. This is normal! Your breasts will get better over time as swelling goes down and tissue heals properly.
• You may have some tenderness in the first few weeks after surgery; this should subside by six weeks post-op (although it might not go away completely). If any pain persists beyond four weeks post-op, contact your doctor immediately–it could mean an infection or other complication requiring treatment from a medical professional immediately.* *

Two Months

At two months, your skin will be completely healed. The breasts will still be very firm and may feel high because the implants have not yet settled into their final position. You should be able to start exercising again at this point–but make sure you don’t overdo it!

Your new breasts may feel a little off at first, but the skin burning after breast augmentation surgery is usually a normal part of the healing process.

Your new breasts may feel a little off at first, but the skin burning after breast augmentation surgery is usually a normal part of the healing process. It’s common for your new breast implants to feel tight or tingly for up to three months after surgery. This sensation should go away on its own as you heal from your procedure, but if it persists longer than that or becomes painful or uncomfortable during this time period (or anytime in between), call your doctor right away so they can assess whether something else might be wrong with your health or recovery process.

skin sensitive to touch after breast augmentation

Numbness is a normal part of any surgical procedure and can be expected for several weeks or months after surgery, as the nerves are traumatised by surgery and may be compressed by swelling. Sensation in the breast and nipple can increase or decrease after augmentation surgery – ranging from a total loss of feeling through to tingling or sharp twinges.

Most loss of feeling will resolve in 2 to 3 months, however, some areas – such as the nipples and the area directly around the scar line – can take up to 2 years to resolve. The last place to regain the sensation will be directly adjacent to the incision, as the nerves make their way from the periphery to the scarline. In some cases, sensation may never return to 100% of what it felt like previously over the scar area.

This is slightly more likely to be the case when breast lift surgery is performed along with the augmentation.

The usual signs of the nerves regenerating is itching, followed by a burning sensation and then occasional sharp pains; these are normal. Sometimes women feel hesitant to touch the numb areas of their breast as they can feel strange and separate from their body, however, it is important to massage and stimulate the nerves to encourage regeneration – you can combine this with your daily scar minimisation massage.

The size of the implant relative to the size of your chest diameter is the most important factor that impacts sensory changes, especially numbness; which is why it is important to select an implant size that is appropriate for your body. Breasts are a normal aspect of female pleasure and there’s no point having the breast size you always wanted, if you can no longer enjoy normal sensation.

The smaller the implant, the less dissection required relative to the base of the breast, and the lower the likelihood that nerves innervating the breast from the periphery of the breast will be disturbed.

contraceptive implant burning sensation

Implantable devices offer convenient, long-acting, and reversible contraception. Injury to the peripheral nerves and blood vessels have been reported as rare complications of implantation and extraction.

Case presentation

We present a case of ulnar nerve injury in a 21-year-old woman from attempted in-office removal of a deeply implanted Nexplanon® device. The injury resulted in an ulnar nerve palsy requiring surgical exploration, neuroma excision, and sural nerve cable grafting.

Conclusions

In-office attempts to remove contraceptive implants that are deep or have migrated can cause iatrogenic nerve injury. Devices that are non-palpable, deep, or migrated should be imaged before formal surgical exploration and removal. Any patient with neurologic symptoms after placement or after attempted removal requires prompt diagnosis and referral to a peripheral nerve surgeon.

Background

Subdermal contraceptive implants, such as the Nexplanon® (Merck, Kenilworth, NJ), are a popular form of long-acting, reversible contraception. Insertion and removal procedures are designed to be safely performed in the outpatient setting with local anesthetic. However, serious complications, including neurovascular injury, can occur [1,2,3,4,5,6]. These complications were more commonly reported with older devices, especially if they were placed deeply or if they migrated proximally. Multiple case reports have described implant-related injuries to the median [2, 3], ulnar [4, 5], and medial antebrachial cutaneous nerves . These reports prompted device modifications and technique adjustments.

Due to safety concerns, the Food and Drug Administration mandated that healthcare providers undergo training and certification before using the Nexplanon® in practice [7, 8]. Current training recommends the Nexplanon® be placed subdermal and “at the inner side of the non-dominant upper arm about 8-10 cm (3-4 inches) above the medial epicondyle of the humerus, avoiding the sulcus (groove) between the biceps and triceps muscles” [9, 10]. Some providers use a different placement site, over the triceps muscle, to place the implant even further away from neurovascular structures of the medial arm, located between the triceps and biceps . To help guard against deep placement, the proper technique involves insertion at an angle of less than 30° . Furthermore, the newly added plastic barrier over the insertion needle is designed to guide the Nexplanon® into the superficial layer below the dermis [12, 13].

Proper removal technique is also important in avoiding complications. The safest method of extraction involves definitive palpation of the device immediately before attempting in-office removal . Devices may be non-palpable because they were placed deeply or because they have migrated. Contraceptive devices placed in the arm have migrated as far as the shoulder, axilla, chest wall, and even the pulmonary arteries . From the hand surgeon’s perspective, implant migration is a well-documented complication and is known to occur even when an implant is originally placed into solid bone . Merck acknowledges that Nexplanon® migration is a risk and recommends that if the device is not palpable at the time of planned removal, X-ray, computed tomography (CT), ultrasound, or even magnetic resonance imaging (MRI) can be used to aid location .

Even with the mandated training, technique guidelines, and design improvements, serious complications can still arise. Merck maintains a database of deep implants and complex removals . The complication we present is the first case reported of ulnar nerve injury during attempted in-office removal of a deep Nexplanon®. The patient required formal surgical exploration for implant removal, resection of an ulnar nerve traumatic neuroma, and reconstruction of the ulnar nerve.

Case report

A 21-year-old woman presented to our hand and peripheral nerve clinic 4 months after attempted Nexplanon® removal from her left arm. The patient reported that neither she, nor her nurse practitioner (NP), was confidently able to feel the Nexplanon® before the attempted removal. Imaging studies to confirm location of the Nexplanon® were not performed. The patient remembered a small incision being made at the site of insertion after local anesthetic was injected. The provider was not immediately able to find the Nexplanon®, but after exploring the local area, did grasp another structure in her arm. The patient felt an “electric shock” sensation that radiated down to her medial elbow as the NP pulled. No further attempts to remove the Nexplanon® were undertaken.

Immediately after the removal attempt, the patient had complete numbness in her small and ring fingers. She returned for follow up to her NP. As months progressed, the numbness did not improve, and she began to notice wasting of her hand muscles and weakness in her grip. At almost 4 months after the attempted removal, her NP ordered a nerve conduction study which showed 50% loss of ulnar nerve function.

On presentation to the office, she had classic signs of severe, chronic ulnar nerve injury: wasting of the ulnar nerve-innervated intrinsic muscles of the hand, a claw position of the ring and small fingers, and dense numbness in an ulnar sensory nerve distribution (Fig. 1). On examination of her arm, there was a well-healed incision with surrounding scar tissue from the extraction attempt. The Nexplanon® was not palpable. X-rays showed the radio-opaque Nexplanon® at the junction of the proximal and middle thirds of the humeral shaft with the most distal end 16.5 cm proximal to the medial epicondyle (Fig. 2).

Given the patient’s history, physical exam, and nerve tests, timely surgical intervention was recommended. In the OR, the upper extremity surgery team used fluoroscopy to mark the location of the Nexplanon® (Fig. 3). On surgical exploration, the Nexplanon® was found deep to the brachial fascia of the arm and in direct contact with the ulnar nerve. Less than five millimeters away was the undamaged brachial artery–the main blood supply to the arm, forearm, and hand. The Nexplanon® was removed using microsurgical instruments.

Because of the patient’s dense ulnar nerve palsy, the ulnar nerve at the level of the attempted extraction was also explored. Dissection showed that the ulnar nerve had been severely damaged at this level (Fig. 4). Nerve injury can take many forms; this patient’s injury was a neuroma-in-continuity whereby the ulnar nerve was still one solid, longitudinal structure, but contained an abnormal portion, filled with scar tissue and damaged nerve fascicles that could not conduct electrical signal. The surgical team confirmed the neuroma’s inability to conduct via intra-operative electrical stimulation. The appearance of her neuroma-in-continuity was classic: the neuroma was fusiform in shape and felt thickened and hard, unlike the proximal and distal, soft and pliable uninjured nerve (Fig. 4a).

The upper extremity surgeons treated the neuroma-in- continuity with microsurgical resection, followed by reconstruction. After the damaged, scarred nerve was removed, there was a 3 cm gap between healthy sections of the ulnar nerve (Fig. 4b). The patient retained three uninjured nerve fascicles which made up less than 20% of the normal diameter of the nerve. The healthy fascicles were dissected free and preserved (Fig. 5b). To bridge the nerve gap, the patient’s sural nerve was harvested from her lower leg, cut into 3 cm long segments and bundled together to recreate the caliber and fascicles of the resected ulnar nerve (Fig. 5). This cabled sural nerve autograft was sutured into place using a surgical microscope and 9–0 Nylon sutures.

At 7 months after nerve reconstruction, the patient had weak grade 2/5 function of ulnar innervated muscles. She still had dense numbness in an ulnar nerve distribution. She did have an advancing Tinel’s sign on physical exam and reported intermittent paresthesias in an ulnar nerve distribution in her hand.

Discussion and conclusions

The presented case is an example of an uncommon, but serious complication from implantable contraception. Peripheral nerve injury from any cause often carries a poor prognosis and causes significant disability for patients. For this patient, both deep implantation and in-office removal of a non-palpable device contributed to the iatrogenic nerve injury. The medial arm is a dense anatomic area where precise device implantation and extraction are required to maximize patient safety. Our patient’s limited recover 7 months after nerve reconstruction is unfortunately not uncommon: the prognosis for recovery after repair or reconstruction is particularly poor for the ulnar nerve [16, 17]. Prompt diagnosis and treatment is crucial to preserve treatment options and maximize a patient’s outcome. It is also important to keep in mind that delayed or incomplete treatment of nerve injuries, particularly of iatrogenic nerve injuries, can result in significant liability [18, 19].

Peripheral nerves of the arm can be at risk with either insertion or extraction of a contraceptive implant into the arm. The majority of cases have been described with older implantable devices. Specifically, Norplant has been reported to cause transient paresthesias that resolve with removal [20, 21]. Norplant removal has be associated with ulnar nerve injury and with significant scar tissue around the ulnar nerve causing nerve compression with motor and sensory symptoms . Implanon® (Organon International INC, Roseland, NJ) insertion and removal has been linked to sensory-only medial antebrachial cutaneous nerve injury, medial cutaneous nerve of the forearm injury, and transient ulnar nerve sensory deficit after device removal [6, 8, 23]. And, as in our case, the currently available Nexplanon® with it’s updated delivery system and specific insertion and removal technique has been associated with median nerve injury in two cases . Other recently reported cases do not mention the specific device used, but describe injury to the median nerve, medial antebrachial cutaneous, and ulnar nerves in a single patient and structural injury to the ulnar nerve in another patient [4, 5].

We emphatically agree with the current manufacturer recommendations: insertion should avoid the sulcus between the biceps and triceps where the median nerve, ulnar nerve, brachial artery and vein are located . Furthermore, our case strongly supports the manufacturer’s recommendation that extraction should not be attempted without knowing the exact location of the device . It is the senior author’s opinion that in-office placement and removal should be performed or directly supervised by an experienced physician who has undergone the appropriate implant-based training.

Since deep implantation and migration are possible, imaging studies should be used to precisely localize migrated or non-palpable devices before removal. In one paper describing operative removal of 28 implantable contraceptive devices, 30% of implants had migrated from the insertion site with 37% lying intramuscular and 11% lying in the neurovascular sheath . Imaging studies should also be done for any patient who develops neurologic symptoms. X-ray, CT, MRI, and ultrasound can all be used to precisely identify an implant’s location. X-ray and ultrasound are both inexpensive, accessible, and non-invasive imaging modalities. While ultrasound offers a zero-radiation technique for localization, X-ray machines and radiologist interpretation are widely available and relatively inexpensive. Although X-ray does involve ionizing radiation, two standard views of the humerus only exposes a patient to 0.001 mSv of radiation . This is the same amount of radiation an average US habitant sees by simply being exposed to our environment for 3 h .

Multidisciplinary care involving family planning practitioners and peripheral nerve surgeons for complex removal improves patient care and optimizes safety . Nerve surgeons can have a hand surgery, orthopaedic surgery, plastic surgery, or neurosurgery background. Symptoms that can indicate an iatrogenic nerve injury at the time of placement or removal include electric or shock-like pain, numbness, or weakness in the distribution of a peripheral nerve. Physical exam findings can include decreased sensation to touch and hand or forearm weakness. Late signs of untreated nerve injury include visible muscle wasting or abnormal posturing such as our patient’s ulnar claw hand.

Prompt referral to a peripheral nerve surgeon is crucial because the motor end plates and end target muscles irreversibly degenerate without nerve input . After nerve repair or grafting, nerves regenerate at a rate of approximately 1 mm per day . As a rule of thumb, if the newly advancing axons do not reach the muscle by 12 months after injury, the damage is permanent and no meaningful functional recovery is made .

Even though there are surgical options for timely nerve repair and reconstruction, normal sensation and strength almost never return. Loss of ulnar nerve function is devastating for patients as the ulnar nerve is responsible for extrinsic and intrinsic hand muscles, as well as crucial hand sensation . Sural nerve autograft is the current gold standard in major peripheral nerve reconstruction. Taking the sensory sural nerve from the leg universally results in lateral foot numbness . In addition, a small percentage of patients have lasting neuropathic pain from this iatrogenic sural nerve injury .

In conclusion, Nexplanon® related major peripheral nerve injuries are an uncommon but possible complication. We recommend documenting the precise location of the implant with careful physical exam after insertion and before extraction. If a patient develops nerve symptoms in the setting of a non-palpable implant or migrated device, imaging and prompt referral to a peripheral nerve and upper extremity surgeon is strongly recommended. Experienced referral centers can be located by contacting the manufacturer.

why do my breast implants hurt 2 years later

Breast augmentation remains one of the most common and popular plastic surgery procedures performed in the U.S., and it has a low risk of complications – the most common being breast pain, changes in nipple and breast sensation, scar tissue formation, and rupture and deflation.

However, a small number of women experience a compilation of symptoms that has come to be known as breast implant illness, or BII. Though we are still learning about BII, and it is not a formal diagnosis, several new studies are investigating potential causes for the symptoms, which are wide-ranging and very real.

More than 100 symptoms have been associated with BII. Some of the most common include:

Breast implant illness has become more widely known in the last couple decades as patients have increasingly shared their stories on social media. In April 2022, retired race car driver Danica Patrick posted on Instagram about her struggles with BII and her decision to have her breast implants removed.

While it can be comforting to find a community of people with similar symptoms as you, unfortunately, sometimes these channels help spread misinformation or unnecessary fear.

Many patients with BII symptoms can find relief without having to remove their breast implants. In some cases, the cause of symptoms is an underlying condition that affects the immune system or hormone production.

If you develop unexplained symptoms that you suspect may stem from your breast implants, talk with a board certified plastic surgeon. We will listen to you and try to determine what the cause of your symptoms are and connect you with specialists if need be.

Determining the cause of your symptoms

Symptoms can occur with any type of breast implants and can start immediately after implantation or years later.

Because so many BII symptoms are associated with other conditions, it’s important to rule out causes unrelated to the breast implants. For example, many similar symptoms are associated with autoimmune conditions such as lupus, rheumatoid arthritis, scleroderma, and Lyme disease. Hypothyroidism, menopause, and fibromyalgia also can cause symptoms similar to those of BII.

Our goals in diagnosis are to determine the cause of your symptoms and to make a plan to resolve those issues at the source. In some women, the implants themselves prove to be the issue, such as if the implant or tissues surrounding it stiffen, or if the implant ruptures. For many more, an underlying condition is the culprit.

Diagnosis starts with a conversation about what triggers your symptoms and the extent to which they interfere with your quality of life. From there, we may refer you to a specialist in areas such as:

If the specialists find an underlying condition, unrelated to your breast implants, treatment for that condition should relieve or eliminate your symptoms. If no underlying conditions are found, we’ll discuss potential next steps, such as removing your implants.

Deciding whether to remove your breast implants

Choosing to remove your breast implants is just as big a decision as it was to get them, and yet more women made that decision in 2021 than in previous years. According to statistics from The Aesthetic Society, 148,000 women had implants removed and replaced (up 32% from 2020), and 71,000 had their implants removed and not replaced (up 47%), though it’s unclear what role if any BII played in the increase.

If you’re unhappy with the size or shape of your implants, or if you’ve developed a complication such as capsular contracture – the formation of hard, stiff scar tissue around the implant – the decision to remove them may reduce your symptoms.

But if you are satisfied with your appearance and your symptoms are systemic, rather than directly associated with the breasts, the decision can be more difficult. Even if BII symptoms resolve after implant removal, adjusting to changes in your appearance can be challenging.

Your plastic surgeon will discuss all options with you to help you make the best decision.

Clearing up common myths related to BII

There are many websites and social media groups dedicated to breast implant illness. And it’s not unusual for patients to tell us they read or saw something that worries them in one of these communities. We’d like to address a couple of the more common concerns.

Sagging skin after implant removal: There are a lot of people who post photos of themselves after having their implants removed. These photos are usually of women who had very large – 400cc or 500cc – implants removed, leaving excessive, sagging skin behind. Images like these can cause unnecessary anxiety.

Transferring fat to the breast from elsewhere in the body can help restore some volume after implant removal. Though your breasts likely will not be as full as they were with implants, this process can provide a pleasing appearance and a less dramatic transition.

“Only one right” way to remove implants: There are several methods to safely remove breast implants:

However, many social communities say that only specific procedures – notably en-bloc capsulectomy – will eliminate BII symptoms. This is untrue, and there are situations in which that procedure could cause more problems. For example, if the capsule is stuck to the chest wall, taking it all out could cause a pneumothorax, or air to leak into the space between the lungs and chest wall. In this case, we can take out most of the capsule and cauterize the patch that’s against the ribcage.

Additionally, removing the capsule and implant together (en-block) may require a longer incision, especially for women who have only had an augmentation and not a breast lift plus augmentation.

Current research and action related to BII

Research is under way to determine the degree to which certain symptoms are directly caused by breast implants and what effect, if any, removal has on those symptoms.

A study published in December 2021 found that the type of breast implant removal performed did not affect the reduction of breast implant illness symptoms.

Part two of this study investigated concerns, expressed on some BII websites, that the presence of heavy metals in silicone and saline breast implant capsules are a primary cause of systemic symptoms and health problems. More than 20 heavy metals were studied and some participants with BII symptoms had statistically higher levels of arsenic and zinc in their breast implant capsules compared with participants who didn’t exhibit BII symptoms. But the measured levels were all below what is considered acceptable exposure levels by regulatory agencies.

Also, the research confirmed that fewer heavy metals were detected in breast implant capsules than in breast tissue from patients who never had implants. Among participants with BII symptoms, there was a higher number of current or former smokers using tobacco and marijuana and a greater number of women with gluten allergies, suggesting that environmental exposure and personal choices related to cigarette smoking, marijuana use, tattoo pigments, and dietary sources may be the source of a BII patient’s exposure to heavy metals.

Based on this research, heavy metal toxicity should not sway a patient’s decision to remove her breast implants.

Finally, it’s important to note that a BII task force has been established within The Aesthetic Society to conduct research and follow new breast implant patients for more than 10 years in hopes of establishing more definitive data and finding more answers for patients and providers.

We understand it can be extremely frustrating to feel unwell without a specific diagnosis – especially after you’ve been through one or more major breast surgeries. Our breast plastic surgery and specialist teams work together, dedicated to providing you with evidence-based care that will get you to the ultimate goal of feeling better.

If you experience symptoms or complications that you suspect may be related to breast implants, call 214-645-8300 or request an appointment online.

A breakthrough in breast reconstruction at UTSW

When Renee Mallonee found out she was BRCA2 positive and her lifetime risk of breast cancer was high, she took the news very seriously. After 15 years of screenings and tests every six months, in 2020 she turned to UT Southwestern and became the first patient in the United States to receive a single port robotic nipple-sparing mastectomy.