Post Mastectomy Pain Syndrome

BACKGROUND

Post-mastectomy pain syndrome (PMPS) is a chronic pain condition that can affect individuals following a mastectomy, which is the surgical removal of one or both breasts often performed as a treatment for breast cancer or for the prevention of breast cancer. While some discomfort is to be expected after any surgical procedure, this syndrome is characterized by persistent pain in the chest, armpit, and arm areas usually lasting more than six months following the operation. The incidence of PMPS has been reported to be as high as 50% in some studies. The pain is often, but not always described as burning, stabbing, or throbbing and can be accompanied by sensations such as numbness, tingling, or itching. Understanding the causes of PMPS is essential for prospective patients as it can significantly impact their quality of life and daily functioning.

CAUSES

The exact cause of PMPS is not entirely understood in every patient, but in many cases is related to nerve damage or nerve irritation that occurs during surgery and during the healing process. Most women are completely numb after their mastectomy because the nerves that provide sensation to the breast tissue, breast skin and nipple/areolar complex are cut during this procedure. Unfortunately, in cases of patients with PMPS, it is thought that these nerves have regenerated in a disorganized fashion thus creating painful nerve ends (i.e., neuromas) that cause discomfort. Additionally, scar tissue formation, muscle tightness, and lymphedema (swelling caused by lymph fluid build-up) can contribute to the pain independently or by secondarily affecting the nerves mentioned above, resulting in symptoms. There are a number of risk factors for developing PMPS including the extent of the surgery, radiation therapy, and individual pain sensitivity.

WHAT CAN I DO?

Managing PMPS initially involves a multidisciplinary approach tailored to the individual patient’s needs. Treatment options may include medications, physical therapy to improve mobility and reduce muscle tightness, or steroid injections that can provide targeted pain relief for some period of time. Some patients may also benefit from complementary therapies such as acupuncture, massage, or relaxation techniques to manage symptoms. Unfortunately, in many cases, these more conservative modalities fail because of direct damage to the nerves themselves. In these cases, an evaluation with an experienced peripheral nerve surgeon can identify the problem with the help of diagnostic nerve blocks. If successful, an outpatient surgical procedure can be designed to address these neuromas and hopefully provide significant and permanent pain relief.

Dr. Peled has performed many operations on these very nerves. If you would like to learn more about this potential treatment option, please reach out to us to set up a consultation.