Post-Surgery Nipple Pain and Complications

Nipple issues

Hello Doctor, I underwent nipple inversion reconstruction surgery at the beginning of January.
However, about three months post-surgery, I started experiencing pain around the nipple area along with a hard lump.
During my follow-up visit, the doctor mentioned it might be related to the sutures and suggested further monitoring (although he had previously stated that the sutures used were absorbable).
An ultrasound was performed, but no issues were detected, and the responses I received were quite uncertain.
Now, about six months later, the pain persists, and the lump remains.
I have even woken up in the middle of the night due to the pain.
The ultrasound did not reveal any cause.
I would like to ask the doctor what this situation might be.
Thank you!

Ani, 20~29 year old female. Ask Date: 2019/07/27

Dr. Chen Jiaming reply Surgery

The nipple is the convergence point of the milk ducts.
Surgical procedures may disrupt the original ductal system, potentially leading to obstruction at the outlet, especially if the nipple was previously inverted.
This can cause retention of secretions in the milk ducts beneath the nipple, resulting in a feeling of fullness or pain (a lump-like sensation), which is typically more pronounced before menstruation.
During this time, taking acetaminophen can provide temporary relief, but a longer adaptation period is usually necessary.
However, after childbirth and during breastfeeding, one may experience significant breast engorgement, and it is advisable to initiate weaning immediately postpartum.

Reply Date: 2019/07/27

More Info

Post-surgery nipple pain and complications can be quite distressing, especially after a procedure like nipple reconstruction. It's important to understand that while some discomfort is expected following surgery, persistent pain and the presence of hard lumps can indicate underlying issues that need to be addressed.

Firstly, it’s crucial to recognize that the healing process after any surgical procedure can vary significantly from person to person. In your case, having undergone nipple reconstruction, the pain and hard lumps you are experiencing could be attributed to several factors:
1. Scar Tissue Formation: After surgery, the body naturally forms scar tissue as part of the healing process. This scar tissue can sometimes become thickened or fibrous, leading to a sensation of hardness around the surgical site. This can also contribute to discomfort or pain, especially if the scar tissue is pressing against nerves or other sensitive structures.

2. Suture Reaction: Even if the sutures used in your surgery are absorbable, there can still be a reaction to the material. Some individuals may experience localized inflammation or irritation from the sutures, which can manifest as pain and the formation of lumps. If your doctor suspects that the sutures are causing issues, they may consider removing any non-absorbable remnants if they are still present.

3. Infection or Inflammation: While your ultrasound did not show any obvious problems, it’s still possible to have a low-grade infection or inflammation that might not be easily detectable. Symptoms of infection can include persistent pain, swelling, and sometimes redness or warmth in the area. If you notice any changes in the appearance of the nipple or surrounding skin, or if you develop fever or increased pain, it’s essential to seek medical attention promptly.

4. Nerve Sensitivity: Surgery can sometimes lead to changes in nerve function or sensitivity in the area. This can result in pain that feels sharp, shooting, or even burning. If the nerves were manipulated or if there was swelling that affected nerve pathways, this could explain the pain you are experiencing, especially if it disrupts your sleep.

5. Capsular Contracture: In cases where implants are involved, capsular contracture can occur, where the scar tissue around the implant tightens and causes discomfort. While this is more common in breast augmentation, it’s worth discussing with your surgeon if you had any implants placed during your nipple reconstruction.

Given that you have been experiencing these symptoms for several months, it is advisable to follow up with your surgeon or a specialist in breast health. They may recommend further imaging studies, such as an MRI, to get a clearer picture of what is happening beneath the surface. Additionally, they might consider a physical examination to assess the area more thoroughly.

In the meantime, managing pain with over-the-counter pain relievers, applying warm compresses, and avoiding activities that exacerbate the pain may provide some relief. However, these measures should not replace professional medical advice.

In summary, while some discomfort is normal after surgery, persistent pain and the presence of hard lumps warrant further investigation. It’s essential to communicate openly with your healthcare provider about your symptoms and concerns to ensure you receive the appropriate care and support.

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