Should I be concerned with a lump after breast augmentation?

I know that it’s common for breasts to feel hard in certain places after surgery, but when should I be concerned that something else might be happening? I read that certain lumps could be the sign of an infection. There is one lump that has formed in my right breast near the nipple. It's been 3 weeks since I had surgery, and it hasn’t gotten any worse, but hasn’t gotten better either.

pattybe

F, 32, New Jersey

While breast lumps are quite common after breast augmentation surgery, they understandably represent a source of concern because of the associations with breast cancer. It is best to schedule a visit with your plastic surgeon or your primary care doctor to carry out some tests to determine the nature of the lump.

Clinical research shows that most breast cancers are found in older women, and rarely in patients younger than 25 unless there is a family history of breast cancer. Your medical provider will possibly recommend that you undergo a clinical breast examination, imaging, or a biopsy to rule out malignancy.

Many women with breast implants are encouraged to have an MRI scan to check for abnormalities in addition to a mammogram, ultrasound imaging, or physical examination. MRI scans use a magnetic field to produce accurate and detailed images of the breast from side-to-side, top-to-bottom, and front-to-back. It’s a useful tool for detecting breast cancer because it can pick up on smaller lesions that mammograms can miss. Mammograms also have difficulty assessing the breast tissue of women with implants because they can’t penetrate the silicone or saline implants to check the breast tissue underneath.

However, if there is no history of breast cancer in your family and you are under the age of fifty, it’s most likely that the lump you’ve found is a cyst or a breast mass caused by fat necrosis, seroma, scar tissue or inflammation in a lymph node or duct. These benign lumps often appear in the immediate postoperative period and will usually subside on their own. In rare cases, silicone implants can be affected by a condition called capsular contracture where fibrous tissue forms around the implant, sometimes causing large, hard lumps.

I would highly recommend returning to your plastic surgeon so they can assess the lump, and to your physician, so he or she can examine it. It’s always better to be safe than sorry.

Dr. Reza Momeni has 12 Breast Augmentation before & afters:

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In the first three months after breast augmentation surgery, it is common to experience lumps. Seromas, hematomas, cysts, fat necrosis, benign tumors, granulomas, inflamed lymph nodes, and folds or ripples in the breast implant can all cause swelling and lumps in the postoperative period. Some benign lumps also arise as a result of the incisions made during surgery, where ducts have been dissected and obstructed, or scar tissue has formed.

These lesions generally go away on their own and are not a symptom of malignancy. Most lumps improve over a six month period, and for this reason some surgeons choose to defer mammograms for six months after surgery.

However, there is also the possibility that a lump that appears after breast augmentation can be malignant and caused by breast cancer. Early detection of breast cancer is imperative, which is why it is essential that you return to your plastic surgeon and a physician to check the lump out.

A diagnostic mammogram and breast ultrasound will determine the cause of the lump and whether further tests are needed. In the majority of cases, lumps in the breast tissue after augmentation surgery are benign and present no cause for alarm. But it’s always better to be safe and check, if only for your own peace of mind.

You didn't mention whether you underwent a pre-surgical mammogram. Many plastic surgeons require certain patients to undergo a mammogram before their implants are inserted so there is a pre-surgical baseline for their breast health. Women aged 45 or older who are at a higher risk of developing breast cancer and women with a family history of breast cancer are specifically recommended to have a mammogram performed before surgery. Preoperative mammograms diagnose any significant disorder and can later be compared to more current mammograms for effective identification of issues.

Hi.  Any lumps in your breasts should be evaluated by your surgeon.  Most are benign and nothing to be too concerned about.  They usually go away on their own after surgery.  But it is best to get your surgeon to examine you to make sure that it isn't a lump that needs further workup.  Good luck!

Dr. Jonathan Heistein has 17 Breast Augmentation before & afters:

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Hi Patty,

You did not say whether it is painful or not. In the absence of any other sign of infection- redness, swelling, pain, warmth- the likelihood that this lump is an infection is very small. If it truly was not there before surgery, then the close time frame suggests it is related to your surgery. If your implants were saline, you may be feeling the hard bump where the fill valve is in the implant. Cysts can develop anytime and, in a 30 year old women, are quite common. The chances that this is a cancer are very remote. You should definitely bring this to your surgeon's attention right away and have him or her check it out. The most likely course will be to follow this for a few months and see what happens to it. Mammograms are often difficult to interpret in young women because the breast tissue is dense and difficult to see through. When there is an implant in, this can cause a shadow that can obscure small areas of the breast from examination. I don't believe you have anything to be overly worried about, but your surgeon should be informed. 

Sincerely, 

R. Bosshardt

If your breast surgery was performed through the nipple then what you're feeling is what I describe as a healing ridge.  This is normal tissue healing and is often more palpable on one side than the other.  If it was performed through an incision below the breasts are in the arm.  And then this developed he may want to have your surgeon check it out.

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