Manuel A. Torres-Salichs MD,FACS Surgical Oncology, Breast Surgeon

Edileidis Tarrio, ARNP-BC, OCN





Post Mastectomy Syndrome

A variety of pain syndromes have been described in women who have undergone surgical treatment for breast cancer. These include pain at the scar, chest wall, and upper arm. They also develop shoulder discomfort, phantom breast tactile sensations, and pain.

Causes of Post Mastectomy Syndrome:
The causes of post mastectomy pain syndrome remain unclear, but are probably due to several factors. The most commonly cited theory of chronic postoperative pain in breast cancer patients is the intentional sacrificing of the intercostobrachial nerves. These nerves run through the axillary region into the arm. They give sensation to the posterior aspect of the arm. Additional factors include neuropathies caused by chemotherapy and radiation therapy. Post mastectomy pain is associated with difficulty in performing physical and recreational activities, increased body image distress, and decreased sexual interest and functioning. It is estimated that up to 50% of patients will suffer persistent pain after breast surgery due to injury to the intercostobrachial nerves. Injury to the nerves will result in neuromas due to ineffective regeneration and swelling within the nerves.

Clinical Presentation:
Neuralgic quality pain (burning, shooting) associated with hypersensitivity, numbness, tingling, and muscle weakness depending on whether the nerve involved is purely sensory, purely motor, or mixed sensory, motor. Allodynia may be present. This is pain from a stimulus that does not normally cause pain, i.e., clothing or sheets touching the skin where the skin may become easily irritated.



A pain specialist should be part of the medical team
Physical therapy
Topical agents
Scar desensitization injections with dilute local anesthesia and steroids
Nerve block