Can breast implants cause pain years later?

Breast implants are a common plastic surgery procedure performed for cosmetic or reconstruction purposes. While most women who get breast implants are satisfied with the results, some do experience complications that can emerge years down the line. One such complication is breast implant-associated pain that develops over time.

Table of Contents

What causes breast implant pain years later?

Some potential causes of breast implant pain years after surgery include:

Capsular contracture – Scar tissue forms around the implant, squeezing it and causing pain. This is one of the most common reasons for late-onset breast pain.
Implant rupture – The outer shell of the implant breaks, causing pain and swelling as the contents leak out.
Implant malposition – The implant shifts out of place, leading to distortion and discomfort.

Tissue stretch – The tissues overlying the implant are stretched too far and become painful.
Infection – A subclinical infection around the implant emerges years later, resulting in inflammation and pain.
Hematoma – Bleeding into the space around the implant causes painful buildup of blood.

Bottoming out – The implant drops lower on the chest, causing pain from tension on surrounding tissues.

What are the symptoms of late onset breast implant pain?

Symptoms that may emerge years after breast augmentation due to implant-related complications include:

Breast pain – Can range from mild to severe.

Breast hardness or feeling of fullness – From scar tissue or fluid accumulation around the implant.
Changes in breast shape – Due to distortion from scarring or implant malposition.
Redness, swelling or warmth – Signs of infection or inflammation.

Tingling, numbness – Nerve compression from scar tissue or implant.
Lumps – Potential sign of rupture with silicone gel leaking out.
Recurrent infections or rashes – Due to a subclinical infection emerging years later.

The symptoms are often localized to the affected breast, but pain can sometimes radiate to the underarm, chest wall or back as well.

How common is late onset breast implant pain?

Studies estimate that 20-30% of breast augmentation patients experience pain as a late-occurring complication. Some key statistics on the prevalence of delayed breast implant pain:

Capsular contracture occurs in up to 22% of patients, typically 2-5 years after surgery.

Implant rupture causes pain in 13-24% of patients 5-10 years post-surgery.
Bottoming out occurs in around 18% of breast implants after 3 years.
Infection rates are around 2-2.5% occurring years after implant placement.

So while a significant portion of women do develop late-onset pain from their breast implants, most patients have uneventful, symptom-free outcomes long-term.

When does late onset breast implant pain typically develop?

Here is a timeline of when patients tend to first experience breast implant-related pain years after their surgery:

Complication	Onset of Pain
Capsular Contracture	2-5 years post-surgery
Implant Rupture	5-10 years post-surgery
Implant Malposition	1-3 years post-surgery
Tissue Stretch	3-5 years post-surgery
Infection	Can occur any time years later
Hematoma	Most within 1-2 years post-surgery
Bottoming Out	3+ years post-surgery

As shown in the table, while each complication has a typical timeframe, pain can really emerge at any point years after the initial surgery. This demonstrates the importance of ongoing follow-up and monitoring for implant patients.

Should breast implants be replaced to treat late onset pain?

In some cases where the implant itself is causing pain from contraction, rupture or malposition, surgical replacement can relieve symptoms. However, it may not be the best option for every patient.

Replacing contracted capsules provides relief in about 50% of cases. The contracture may recur with the new implants.
Replacing a ruptured silicone implant stops leakage and compression on tissues.

Replacing malpositioned implants can allow better positioning.
But implant replacement has similar risks as the initial surgery like infection, scarring, loss of nipple sensation, and pain.
And the new implants can also develop issues like rupture or capsular contracture again down the line.

Thus patients and providers need to have an informed discussion about both the potential benefits and drawbacks of replacement surgery for painful implants.

Are there non-surgical treatments for pain from breast implants?

There are some more conservative treatment approaches that may relieve pain without needing full implant removal or replacement surgery:

Massage – Can help break down scar tissue contractures and adhesions causing pain.

Ultrasound – Applying ultrasound waves transdermally can also help soften scar tissue around implants.
NSAIDs – Over-the-counter non-steroidal anti-inflammatory medications can alleviate inflammation and pain.
Change in implant size/type – Switching to smaller or textured implants may reduce pain without full removal.

Drainage of fluid collections – Draining hematomas or seromas by needle aspiration brings relief.
Antibiotics – Can clear low grade infections manifesting as pain years later.

However, these nonsurgical treatments may only provide partial or temporary relief in severe cases.

Is breast implant removal always necessary for pain?

Not necessarily. While some patients opt for implant removal to definitively resolve chronic pain, others are able to successfully manage symptoms without complete removal.

Key factors to consider:

Severity of pain – Milder cases can be managed nonsurgically, severe intractable pain warrants removal.

Quality of life impact – Degree of pain interference with work, relationships, activities.
Response to other treatments – Trying more conservative options first if appropriate.
Patient preference – Some elect prophylactic removal, others wish to keep implants.

Unilateral vs bilateral pain – Removing just the problem implant may be reasonable.
Cause of pain – Remove if due to recurrent infections, rupture, severe contracture.

So the decision for removal is made on an individual basis accounting for these factors. Patients can reassess over time as new treatments emerge.

Can breast implant illness cause chronic pain?

Breast implant illness (BII) refers to systemic symptoms attributed to breast implants that lack a clearly defined cause. Joint and muscle pain are common symptoms. Theories on what causes these symptoms include:

Immune reactions to implant materials
Toxic effects from silicone leakage

Chronic inflammation around the implant

However, BII is not currently recognized as an official diagnosis by physicians’ groups like ASPS. More research is still needed.

Some key points:

Studies have not found strong data linking implants to defined chronic illnesses.
Symptoms are typically subjective and nonspecific.
It remains controversial if implants can cause systemic pain in the absence of a specific complication.

Pain seems more correlated to local breast/chest wall issues than an implant illness.
Removing the implant results in resolution of pain for some patients, but not all.

Overall the evidence is limited on breast implants as an actual source of chronic widespread pain in most recipients.

Does breast implant rupture always require removal?

Breast implant rupture refers to a tear or hole in the outer shell of the implant. With silicone gel-filled implants, this allows the contents to leak into surrounding tissue. Signs of rupture include pain, lumps, and change in breast shape.

While ruptured implants do not always require removal, there are some reasons why it is often recommended:

Prevents worsening leakage of silicone material outside the scar capsule.

Can resolve pain and discomfort caused by the rupture.
Reduces anxiety and worry about potential effects of rupture.
Lowers risk of other issues like capsular contracture developing.

Chance of silent rupture in contralateral implant as well over time.

However, rupture does not automatically mean the implant must be removed. The FDA advises that women with silent rupture and no symptoms may choose regular monitoring instead.

Factors that support non-removal include:

Asymptomatic rupture with no pain or changes
Minimal silicone leakage still contained within scar tissue
Patient preference to avoid additional surgery

So while many plastic surgeons recommend replacement of ruptured implants, asymptomatic patients have the option of careful monitoring if the risks are deemed low.

Does breast implant removal always resolve pain?

Unfortunately, removing painful breast implants does not guarantee complete resolution of symptoms in all patients.

Some key points on why pain may persist after removal:

Chronic neuralgia – Nerve damage from compression can cause ongoing neuropathic pain.
Residual scar tissue – Remaining contractures may still compress or adhere to tissues.
Chronic inflammation – Slow to resolve after implant removal.

Hypersensitivity – Sensitized pain nerves continue firing abnormally.
Secondary changes – Like muscle spasms or posture changes from compensating.
Unknown etiology – Some mechanisms of breast pain remain unclear.

One systematic review found that around 30% of women who underwent implant removal for pain still had persistent symptoms afterwards.

So patients considering explantation surgery for pain should have realistic expectations that there is a chance it may not fully resolve if complex neurogenic or inflammatory processes are still at play.

Can breast implants be left in if painful but intact?

For implants that remain structurally intact but are causing breast pain, it may be reasonable to leave them in place and manage symptoms nonsurgically.

This avoids additional surgery if:

Exams and imaging show the implants are not ruptured or leaking.
No signs of infection like fever or purulent drainage.

The pain is tolerable and responds to conservative measures.
The patient prefers to retain her implants if possible.

Symptomatic but intact implants can be managed by:

Oral pain medications like NSAIDs, muscle relaxants, neuropathic agents
Physical therapy to improve posture, chest mobility
Massage techniques to breakdown contractures

Compression to limit implant movement
Injections of steroids or anesthetics for targeted relief

This allows implants to remain while controlling pain. However, if quality of life is significantly impacted by constant discomfort, removal may still be the best option.

Conclusions

Breast implant complications like rupture, contracture, and malposition can cause breast pain years after the initial surgery.
Pain typically emerges around 2-5 years post-surgery but delayed onset pain is possible.
Replacing implants may help if they are structurally damaged but pain could recur.

Nonsurgical treatments aim to manage discomfort and avoid additional surgery.
Implant removal may be considered for intractable pain but is not always curative if pain mechanisms are complex.
Careful monitoring and shared decision-making are key for patients with painful breast implants years later.