Immediate and long-term phantom breast syndrome after mastectomy: incidence, clinical characteristics and relationship to pre-mastectomy breast pain

Abstract

Phantom breast syndrome (PBS) following mastectomy has already been reported by other authors. The temporal course, character and extent of these phenomena, however, have not yet been elucidated. In a prospective study, we investigated the incidence, clinical picture and the temporal course of PBS. One hundred and twenty women who, during a 1 year period, embarked consecutively on post-operative control or treatment at the department, were interviewed by a standard questionnaire 3 weeks after the operation. One year later 110 patients were interviewed again. The median age at the first interview was 54 years (Q1 = 45 years; Q3 = 62 years). The incidence of PBS was 25.8% at the first interview and 24.5% at the second. The incidence of phantom pain and non-painful phantom sensations was 13.3% and 15.0%, respectively, 3 weeks after mastectomy and 12.7% and 11.8%, respectively after 1 year. We found significant relationships between pre-operative pain and PBS, but no significant relation between age and the occurrence of PBS. Neither post-operative sequelae nor cancer treatment including radiotherapy seemed to affect the occurrence of PBS. Exteroceptive-like pain emerged as the most predominant type of pain from both interviews. At the time of the first interview, 35.0% of the patients experienced cicatrix pain which was clearly distinguishable from phantom pain; after 1 year, 22.7% of the patients had persistent cicatrix pain. The present incidence of PBS is close to the incidence reported by others. Persistent phantom pain may, however, be more common than usually expected. Also persistence of cicatrix pain seems to be more common than generally expected.

Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence

“…There is also a literature on the persistence of painful and non-painful sensations associated with removal or deafferentation of body structures other than the limbs, including breasts (Kroner et al 1989), teeth (Hutchins and Reynolds 1947;Reynolds and Hutchins 1948), and internal and special sense organs. Ulcer pain has been reported to persist after vagotomy (Szasz 1949) or subtotal gastrectomy with removal of the ulcer (Gloyne 1954).…”

Psychophysiological Contributions to Phantom Limbs

“…The aggravation or alleviation of pain in phantom body parts also may be mediated in part by psychological processes that alter anxiety levels (95). Phantom breast pain after a mastectomy was found to be provoked by emotional distress in six percent of women three weeks after surgery and in 29% one year later (96). One-half of all lower limb amputees report that attacks of phantom limb pain can be brought on by emotional distress (12) as long as seven years after the amputation (97).…”

Phantom pain after eye amputation

“…Up to 80% of patients with limb amputation experience phantom pain (Flor 2002), and as many as 70% are troubled even 25 years after amputation (Sherman et al 1984). Phantom sensations and pain after amputation have been described in various organs: limbs (Sherman et al 1984;Jensen et al 1985;Flor 2002), mammae (KroneMunzebrock 1950;Kroner et al 1989), rectum (Ovesen et al 1991), larynx (Mal & Baldwin 2009), teeth (Marbach 1996), parts of the face (Hoffman 1955), bladder (Bors 1951), uterus and even the appendix (Ramachandran & Hirstein 1998).…”