One of my recent Milwaukee breast augmentation patients noted pain under her left breast, in the region of the lateral portion of the inframammary fold incision about two weeks following surgery. Her exam at that time showed a bit more swelling and tenderness of the skin closure on this left side, compared to the right, but there were no other changes. At her one month follow-up evaluation she noted some persistent soreness in that same area along the left inframammary crease; in addition, she described a pulling sensation and a band that “looks like a vein.”
This woman has a Mondor’s cord, also known as Mondor’s superficial thrombophlebitis – an inflammatory process that involves superficial veins of the breast and anterior chest wall. The process is named after Henri Mondor, a French surgeon, who first described the condition in 1939. Patients develop superficial pain and swelling of the breast and/or adjacent anterior chest wall that may or may not be accompanied by redness. A tender linear band is often present; this represents the inflamed superficial vein. Mondor’s disease is self-limiting and benign.
After breast augmentation the process usually occurs in the inframammary region adjacent or deep to the incision. The trauma of surgery causes inflammation or thrombosis in one or more veins that cross the inframammary crease. The affected vein becomes swollen and tender, and can be visible as a prominent cord when it is stretched (when the woman raises her arms over her head). Patients may also report a tightening or pulling sensation when an inflammatory cord is present.
The process is self-limiting, meaning that it can resolve without treatment. Many surgeons recommend treatment in an attempt to speed its resolution. Treatment of Mondor’s thrombophlebitis involves warm compresses, non-steroidal anti-inflammatory drugs (NSAID), and massage. A warm compress can be placed over the cord for 10 – 15 minutes, four to six times per day. The breast skin may be numb following surgery so it is important to use caution when applying warm compresses. Anti-inflammatory medications such as aspirin, ibuprofen, and naproxen are helpful in reducing the inflammation and tenderness. Gentle massage of the cord may reduce swelling and promote softening. If the bra irritates the involved area, some padding beneath the bra strap may be helpful.
Mondor’s cords may take up to three months to resolve.
Additional images of Mondor’s disease following breast augmentation: