A Beginner’s Guide to Post-Mastectomy Pain Syndrome

One of the least-discussed aspects of breast and chest surgery is that of long-term changes to the body. Perhaps most overlooked within that already quiet discussion is a chronic pain after mastectomy known as Post-Mastectomy Pain Syndrome (PMPS). This type of long-lasting pain in the breast, chest, and underarm may impact 20-to-70 percent of folks who undergo mastectomy. While the research is ongoing, one thing is for certain: large numbers of patients are suffering for years after surgery. What’s more is that in many cases that suffering is treatable—or even avoidable.
Read on to learn more about the history and management of this undeserved, chronic neurological pain condition.

How long has the medical community known about PMPS?

PMPS’s first medical acknowledgement came over 45 years ago, in 1978. Unfortunately, breast cancer survival rates at that time were not what they are today. Thus treatment was strictly focused on keeping patients alive without concern for quality of life thereafter. Long-term pain was simply a risk of the process.

What causes PMPS?

Nerves run throughout the breast and chest. Standard mastectomy techniques disturb these nerves. Current research shows that nerve damage in the chest, breast, and axillary areas can cause PMPS. This type of damage is difficult to manage. However, PMPS awareness is driving a new wave of mastectomy techniques that center on appropriate nerve handling in the breast. These techniques may reduce or prevent long-term pain.

How is PMPS diagnosed?

The chronic pain associated with PMPS is neurological, which makes nerve pain an essential part of diagnosis. This pain can take a variety of forms, including burning, itching, electric shocks, and other types of unpleasant, unusual sensation.

Patients who have moderate to severe neurological pain in the chest, breast, underarm, or arm area that has persisted for at least six months may be diagnosed with PMPS. The exact criteria vary by institution, but persistent neurologic pain is the most vital element.

What prevention and treatment options are available?

Breast surgeons play a critical role in reducing the risk of PMPS. While it is not possible to undergo breast surgery without cutting nerves, more careful, advanced mastectomy techniques can preserve lengths of nerve to improve long-term outcomes for patients. This is particularly important in the area under the armpit during lymph node dissection. Nerve grafting procedures can also be incorporated into both natural tissue and implant breast reconstruction procedures at the time of mastectomy to further improve sensation and reduce the likelihood of pain.

Treatment options for diagnosed patients can include pain management, physical therapy, local anesthetics (injections) and—for some patients—surgical interventions. You can hear from PMPS patients who were treated surgically here.