Post-Mastectomy Pain Syndrome: Defining Perioperative Etiologies to Guide New Methods of Prevention for Plastic Surgeons

Chappell, Ava G.; Bai, Jennifer; Yuksel, Selcen S.; Ellis, Marco F.

doi:10.29252/wjps.9.3.247

Cited by 31 publications

(25 citation statements)

References 27 publications

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“…Finally, anatomical breast research shows the locations of nerves at risk during mastectomy, suggesting the development of a map for breast surgery to reduce nerve damage. Moreover, targeted muscle reinnervation and regenerative peripheral nerve interfaces were indicated for the prevention of neuroma formation after nerve transection with axillary dissection and mastectomy [20]. On the basis of the findings and opinions above, we present an overview of risk factors and predictors to be used as potential biomarkers in the personalized management of individual PMP.…”

Section: Introductionmentioning

confidence: 98%

Post-Mastectomy Pain: An Updated Overview on Risk Factors, Predictors, and Markers

Calapai¹,

Esposito

Puzzo³

et al. 2021

Life

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After breast surgery, women frequently develop chronic post-mastectomy pain (PMP). PMP refers to the occurrence of pain in and around the area of the mastectomy lasting beyond three months after surgery. The nature of factors leading to PMP is not well known. When PMP is refractory to analgesic treatment, it negatively impacts the lives of patients, increasing emotional stress and disability. For this reason, optimizing the quality of life of patients treated for this pathology has gained more importance. On the basis of the findings and opinions above, we present an overview of risk factors and predictors to be used as potential biomarkers in the personalized management of individual PMP. For this overview, we discuss scientific articles published in peer-reviewed journals written in the English language describing risk factors, predictors, and potential biomarkers associated with chronic pain after breast surgery. Our overview confirms that the identification of women at risk for PMP is fundamental to setting up the best treatment to prevent this outcome. Clinical practice can be planned through the interpretation of genotyping data, choosing drugs, and tailoring doses for each patient with the aim to provide safer and more effective individual analgesic treatment.

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Section: Introductionmentioning

confidence: 98%

Post-Mastectomy Pain: An Updated Overview on Risk Factors, Predictors, and Markers

Calapai¹,

Esposito

Puzzo³

et al. 2021

Life

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“…Capsular contraction could be one of the leading cause of postoperative pain since in our case series we observed an increased pain in both retromuscular and prepectoral without ADM if compared with prepectoral with ADM adoption ( 37 – 39 ).…”

Section: Discussionmentioning

confidence: 58%

Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures

et al. 2022

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BackgroundThe increased incidence of conservative mastectomy operations (nipple- and skin- sparing) has increased the frequency of immediate breast reconstructions (IBR). In order to guarantee patients the best possible aesthetic outcome, the least chance of complications and moreover, the least postoperative pain, the technique with prepectoral prosthetic pocket was recently reconsidered with the use of ADM. This is the first study using Fortiva® in prepectoral breast reconstruction, and it compares the outcomes of three different patient populations (undergoing retromuscular, prepectoral and prepectoral reconstruction with ADM). The authors suggest that prepectoral breast reconstruction with ADM may bring benefits compared to the current standard technique (retromuscular) as well as compared to the prepectoral reconstruction without ADM.MethodsRetrospective data analysis of patients who underwent mastectomy followed by immediate breast reconstruction with silicone implants (DTI), performed by a team of breast surgeons and plastic surgeons. Logistic factor regressions were performed in order to investigate the effects of the three different intervention techniques on the incidence of complications. Fisher's exact test was used to analyze the differences in the occurrence of each complication. Mann Whitney test was used to compare the averages of referred pain. A p value <0.05 was considered significant.ResultsA total of 67 patients underwent DTI reconstruction, of which 43 with retromuscular prosthesis, 13 prepectoral and 11 prepectoral with ADM. We found a significantly lower incidence of surgical complications with ADM, exclusively in comparison with retromuscular reconstruction (p = 0.028). It emerges prepectoral reconstruction with ADM involves significantly less visibility of the implant than both the prepectoral surgery without ADM (p = 0.013) and the retromuscular technique (p = 0.029). Finally, postoperative pain referred at twelfth month is significantly less relevant in the group with prepectoral prosthesis and ADM, both in the group with retromuscular (p < 0.001) and prepectoral without ADM (p = 0.001).ConclusionsThis study demonstrates that immediate prepectoral breast reconstruction with ADM is a safe and reliable technique, able to exceed some type of limits imposed by prepectoral reconstruction. Moreover, it provides benefits if compared to the current standard technique. In the future, this technique could also be added to it, after a proper selection of patients in pre- and intraoperative time.

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“…These may be considered as the classic etiologies of post-mastectomy pain, which occur due to nerve insult from surgery and/or radiation therapy. Recent reviews from Kokosis et al and Chappell et al have categorized etiologies of pain based off which nerves are injured building off the classification of neuropathic pain following breast surgery proposed by Jung and colleagues [28,32,37]. These nerves include most notably the intercostobrachial nerve, the anterior and lateral cutaneous branches of intercostal nerves T3-T6, the pectoralis medial and lateral nerves, the long thoracic nerve and the thoracodorsal nerve.…”

Section: Neuropathic Sources Of Painmentioning

confidence: 99%

A Targeted Approach to Post-Mastectomy Pain and Persistent Pain following Breast Cancer Treatment

Chang

Asher

Smith

2021

Cancers

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Persistent pain following treatment for breast cancer is common and often imprecisely labeled as post-mastectomy pain syndrome (PMPS). PMPS is a disorder with multiple potential underlying causes including intercostobrachial nerve injury, intercostal neuromas, phantom breast pain, and pectoralis minor syndrome. Adding further complexity to the issue are various musculoskeletal pain syndromes including cervical radiculopathy, shoulder impingement syndrome, frozen shoulder, and myofascial pain that may occur concurrently and at times overlap with PMPS. These overlapping pain syndromes may be difficult to separate from one another, but precise diagnosis is essential, as treatment for each pain generator may be distinct. The purpose of this review is to clearly outline different pain sources based on anatomic location that commonly occur following treatment for breast cancer, and to provide tailored and evidence-based recommendations for the evaluation and treatment of each disorder.

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Post-Mastectomy Pain Syndrome: Defining Perioperative Etiologies to Guide New Methods of Prevention for Plastic Surgeons

Cited by 31 publications

References 27 publications

Post-Mastectomy Pain: An Updated Overview on Risk Factors, Predictors, and Markers

Post-Mastectomy Pain: An Updated Overview on Risk Factors, Predictors, and Markers

Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures

A Targeted Approach to Post-Mastectomy Pain and Persistent Pain following Breast Cancer Treatment

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