Localization of Chronic Pain in Postmastectomy Patients

Abstract

BackgroundAfter breast surgery with or without immediate reconstruction, chronic pain can be a major problem for patients. However, few studies have examined the details of the sites of long-lasting postoperative pain. In this study, we specified the postoperative pain location after breast surgery, including reconstruction, to find ways to improve surgical procedures or provide effective pain relief.MethodsThe subjects were 205 Japanese women undergoing mastectomy or breast reconstruction with a tissue expander (TE)/implant or a deep inferior epigastric perforator (DIEP) flap. Patients were asked whether they had pain in different parts of the body at 1 year after surgery. Differences were assessed by cross-tabulation and χ2 statistics.ResultsSurveys were completed by 157 subjects. Deep inferior epigastric perforator flap cases had significantly more pain and TE/Imp cases had significantly less pain in the medial breast, upper breast, breast upper medial quadrant, and abdomen (P = 0.006, P = 0.006, P < 0.001, P < 0.001, respectively). In the neck area, pain in TE/Imp cases was significantly worse than that in all other patients (P = 0.025). There was no significant difference in chronic pain in any other body regions among the mastectomy only, TE/Imp, and DIEP flap groups.ConclusionsThe results of the present study revealed that the localization of prolonged postoperative pain after breast surgery differs depending on the surgical procedure. In DIEP flap reconstruction, there was a marked tendency for pain in the inner and upper chest and in the abdomen, whereas TE/IMP surgery resulted in pain around the neck of the affected side. These findings may help improve surgical methods and establish effective pain relief that focuses on the identified pain areas.

Chronic Pain Following Breast Reconstruction

“…In alloplastic reconstruction, Wang et al 53 reported rates of chronic pain in the breast, chest wall, axilla, and arm of 30.2%, 21.4%, 16.4%, and 6.9%, respectively. Among breast surgery options, implant-based reconstruction results in less severe pain in the medial breast ( P = 0.006), upper breast ( P = 0.006), upper medial breast ( P < 0.001), and abdomen ( P < 0.001) at POY 1, whereas infraclavicular pain was specifically observed in implant-based reconstruction ( P = 0.025) 45 . Pain in the infraclavicular region may be due to direct pressure on the brachial plexus in this area following migration of implants 44 …”

“…43,44 Honkanen et al 36 compared the location of chronic pain following implant-based and autologous reconstruction and found no difference in pain between the reconstruction types. However, in similar but larger cohort studies, Shiraishi et al 45,46 found that patients who received autologous reconstruction reported more abdominal pain at postoperative year (POY) 1 (P < 0.001) and POY 5 (P = 0.04), and more upper medial breast pain at POY 5 (P = 0.01) compared to patients treated with mastectomy only. Abdominal pain can be caused by donor harvest, whereas pain in the upper medial breast may be due to rib removal 47 and damage to intercostal nerves in the search for internal mammary vessels.…”