Post-Mastectomy Pain Syndrome

Post-mastectomy pain syndrome (PMPS) is a relatively common condition that can occur in patients after undergoing a mastectomy, lumpectomy, or other breast surgeries. This persistent pain arises due to the cutting, stretching, or injury of sensory nerves during the surgical procedure, which can result in the formation of a neuroma – a painful, ball-like growth at the end of the injured nerve. These injured nerves can cause chronic and debilitating chest wall pain, affecting the patient's quality of life, daily activities, and even their emotional well-being.

The severity and characteristics of post-mastectomy pain syndrome can vary among patients who have undergone breast surgery. Some may experience mild discomfort, while others suffer from intense, sharp, or burning pain. The pain can be localized to the chest wall, underarm, and/or upper arm, and may be exacerbated by certain movements, clothing, or even temperature changes. Additionally, PMPS can develop immediately after surgery or manifest months to years later, making it essential for patients and healthcare providers to be aware of the potential for this condition.

To diagnose an injured nerve following surgery, a thorough medical history and physical examination are conducted. The injured nerve often manifests as neuropathic pain, characterized by a painful burning or tingling sensation. There may also be a focal area of extreme pain that, when tapped, triggers shooting electrical sensations, known as a "Tinel's sign." A nerve block is frequently performed by injecting local anesthetic near the site of the suspected injured nerve. If this results in significant pain relief, it typically confirms the diagnosis of a nerve injury and suggests that surgical treatment could be beneficial. It is important to note that the local anesthetic injection only provides temporary relief and does not cure the pain caused by the injured nerve. The injection's purpose is solely for diagnostic and treatment planning purposes.

Historically, treatment options for post-mastectomy pain syndrome primarily involved medications (such as opioids, nonsteroidal anti-inflammatory drugs, and nerve pain medications), physical therapy, nerve stimulation techniques (like transcutaneous electrical nerve stimulation), or patients simply "dealing with" the pain. However, these treatments often provide only partial or temporary relief and do not address the underlying issue: the injured nerve that once connected to the breast tissue now has no target.

Advancements in surgical techniques have provided new options for addressing the root cause of PMPS. By giving the nerve a new destination and function, post-mastectomy chest wall pain can be significantly improved. This can be accomplished through various surgical procedures, including:

Neurectomy: This involves the removal of the injured nerve or neuroma, which can help alleviate pain by preventing the nerve from sending pain signals.

Nerve burying: The injured nerve is surgically implanted into surrounding muscle or soft tissue, which can reduce irritation.

Nerve grafting: A donor nerve segment is used to bridge the gap between the injured nerve and its target, promoting nerve regeneration and reducing pain.

Regenerative Peripheral Nerve Interface (RPNI): This innovative procedure involves connecting the injured nerve to a small piece of muscle, which serves as a new target and helps the nerve grow without forming a painful neuroma.

Surgery for post-mastectomy pain syndrome can typically be performed as an outpatient procedure, with patients returning home on the same day. Localized post-operative pain is expected, but it usually improves quickly. The underlying chest wall pain often shows rapid improvement after surgery, resulting in significant pain relief for the patient.

Recovery time varies depending on the individual and the specific procedure performed, but most patients can expect to return to their normal activities within a few weeks.

Patients may also benefit from additional supportive care, such as pain management techniques (e.g., over-the-counter medications, heat or cold therapy), counseling or support groups to address emotional aspects of recovery, and lymphedema management if applicable.

Be sure to see an experienced surgeon to treat this condition. Our fellowship-trained specialists at The Buncke Clinic in San Francisco treat patients with post-mastectomy pain syndrome from across the Bay Area and Northern California. Contact us to schedule a consultation.