You Don’t Have To Live with Lingering Post-Mastectomy Pain

Within a few months of a mastectomy or lumpectomy, most of the surgery-related pain should fade away. But for some people, pain – sometimes intense – refuses to leave.

Traditionally, breast surgeons and plastic surgeons have often considered this an unavoidable post-operative pain with no real solution. But with more recent advances and understanding of mastectomies, you don’t have to live forever with post-mastectomy pain syndrome.

What Is Post-Mastectomy Pain Syndrome?

To understand the condition, first consider what happens during a mastectomy or lumpectomy. During the former, your surgeon will remove all or part of your breast. During the latter, a smaller portion of the breast – tissue surrounding a tumor – is removed.

But it’s not just breast tissue that’s removed or damaged during these surgeries. The procedures also remove lymph nodes and slice numerous nerves that run through the chest wall and end at the breast.

The way these nerves recover can be unpredictable. Sometimes the healing process results in a painful nerve scar, called a neuroma. These scarred nerves can develop around the site of the mastectomy procedure, making them vulnerable to touch. In some cases, even wearing clothes can apply enough pressure to aggravate the neuroma. Among the symptoms:

• Pain and tingling in your chest wall, armpit or arm
• Pain in your surgical scar
• Shooting or pricking pain
• Electric shocks
• Intense itching

The intensity of symptoms can vary from mild to severe and can be constant or intermittent. In some instances, a certain movement can trigger the pain. It’s also possible to develop more than one of these nerve scars.

How Common Is It?

Research suggests that 20 percent to 30 percent of patients experience this condition after a mastectomy. The syndrome also can happen after any kind of breast surgery. It is most common after procedures that remove tissue from the upper outside of the breast or the underarm area. According to the American Cancer Society, the risk is higher for women who:

• Are younger and have a full axillary lymph node dissection, which involves the removal of a larger number of lymph nodes
• Receive radiation treatment after their surgery
• Have excess weight
• Have depression or anxiety

Treating Post-Mastectomy Pain Syndrome

Diagnosing the source of your ongoing pain is the first step. A clinical evaluation will determine whether there is still lingering general pain after the surgery, or if it can be pinpointed to one or more locations. The key for post-mastectomy pain syndrome is that the symptoms are reproducible by pressing or tapping on specific areas of your body.

In some instances, prompt steroid injections can help reduce the progression of some of the scarring. But once a neuroma develops, the most effective treatment is surgery.

If the syndrome is suspected, it may be followed by a diagnostic anesthesia block, during which your surgeon injects local anesthesia into the area to see if it relieves the pain. If that works, you may be a candidate for surgical treatment.

The goal of surgery is to locate the scarred nerve and remove it. This is usually done by making a new cut on the site of the surgical scar to reach the site of the neuroma.

To prevent a recurrence of nerve scarring, the procedure takes advantage of the behavior of nerves. When they are cut, they tend to sprout nerve tendrils that search for new tissue to innervate. To give the nerve something to do, the surgeon harvests a small piece of muscle tissue from the surgical area and wraps it around the nerve ending – essentially giving it an ending point.

The procedure has proven effective with good long-term outcomes with immediate relief from the pain.