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Surgery Today
Published in: Surgery Today 8/2023

31-03-2023 | Mastectomy | Original Article

Characteristics and distribution of chronic pain after mastectomy and breast reconstruction: a long-term prospective cohort study

Authors: Makoto Shiraishi, Yoshihiro Sowa, Itaru Tsuge, Akiko Shiraishi, Naoki Inafuku, Naoki Morimoto, Ichiro Nakayama

Published in: Surgery Today | Issue 8/2023

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Abstract

Purpose

Chronic pain following breast surgery is a concern for breast cancer survivors; however, few studies have investigated the localization of persistent postoperative pain. We conducted this study to identify the location of pain following breast reconstruction.

Methods

A total of 213 Japanese women undergoing mastectomy only or breast reconstruction with a tissue expander/implant (TE/Imp) or a deep inferior epigastric perforator (DIEP) flap were enrolled in the study. Questionnaires related to pain location were sent to patients at the end of postoperative year (POY) 1 and POY 5. Multiple comparisons of the types of operation and cross-tabulation were made between the two time points.

Results

Surveys were completed by 107 of the women. Severe pain in the upper medial breast was significantly more common in POY 1 after DIEP reconstruction than after mastectomy only (P = 0.01), whereas abdominal pain was worse in POY 5 after DIEP reconstruction than after mastectomy only (P = 0.04). Pain in the medial arm and axilla had resolved better after TE/Imp (P = 0.03) and DIEP reconstruction (P = 0.01) than after mastectomy only by POY 5, but the difference between TE/Imp and DIEP reconstruction was not significant.

Conclusions

These results show that localization of prolonged postoperative pain following breast reconstruction differs depending on the surgical strategy.
Literature
1.
2.
Gärtner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009;302(18):1985–92.CrossRefPubMed
3.
Ader DN, Shriver CD. Cyclical mastalgia: prevalence and impact in an outpatient breast clinic sample. J Am Coll Surg. 1997;185(5):466–70.CrossRefPubMed
4.
Ader DN, Browne MW. Prevalence and impact of cyclic mastalgia in a United States clinic-based sample. Am J Obstet Gynecol. 1997;177(1):126–32.CrossRefPubMed
5.
Shiraishi M, Sowa Y, Inafuku N. Long-term survey of sexual well-being after breast reconstruction using the BREAST-Q in the Japanese population. Asian J Surg. 2022;S1015–9584(22):00108–17.
6.
Shiraishi M, Sowa Y, Tsuge I, Kodama T, Inafuku N, Morimoto N. Long-term patient satisfaction and quality of life following breast reconstruction using the BREAST-Q: a prospective cohort study. Front Oncol. 2022;12: 815498.CrossRefPubMedPubMedCentral
7.
8.
Murphy BL, Thiels CA, Hanson KT, McLaughlin S, Jakub JW, Gray RJ, et al. Pain and opioid prescriptions vary by procedure after breast surgery. J Surg Oncol. 2019;120(4):593–602.PubMed
9.
De Oliveira GS Jr, Chang R, Khan SA, Hansen NM, Khan JH, McCarthy RJ, et al. Factors associated with the development of chronic pain after surgery for breast cancer: a prospective cohort from a tertiary center in the United States. Breast J. 2014;20(1):9–14
10.
Bruce J, Thornton AJ, Scott NW, Marfizo S, Powell R, Johnston M, et al. Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer. Br J Cancer. 2012;107(6):937–46.CrossRefPubMedPubMedCentral
11.
Shiraishi M, Sowa Y, Fujikawa K, Kodama T, Okamoto A, Numajiri T, et al. Factors associated with chronic pain following breast reconstruction in Japanese women. J Plast Surg Hand Surg. 2020;54(5):317–22.CrossRefPubMed
12.
13.
Ducic I, Seiboth LA, Iorio ML. Chronic postoperative breast pain: danger zones for nerve injuries. Plast Reconstr Surg. 2011;127(1):41–6.CrossRefPubMed
14.
Shiraishi M, Sowa Y, Kodama T, Numajiri T, Taguchi T, Amaya F. Localization of chronic pain in postmastectomy patients: a prospective comparison between patients with and without breast reconstruction. Ann Plast Surg. 2022;88(5):490–5.CrossRefPubMed
15.
Kavouni A, Shibu M. Problems associated with the use of internal mammary vessels as recipients for free flap breast reconstruction. Br J Plast Surg. 1999;52(7):597.CrossRefPubMed
16.
Schwabegger AH, Gschnitzer C, Ninkovic MM. Contour deformity at the internal mammary recipient site. Br J Plast Surg. 1999;52(8):674.CrossRefPubMed
17.
Darcy CM, Smit JM, Audolfsson T, Acosta R. Surgical technique: the intercostal space approach to the internal mammary vessels in 463 microvascular breast reconstructions. J Plast Reconstr Aesthet Surg. 2011;64(1):58–62.CrossRefPubMed
18.
Perttunen K, Tasmuth T, Kalso E. Chronic pain after thoracic surgery: a follow-up study. Acta Anaesthesiol Scand. 1999;43(5):563–7.CrossRefPubMed
19.
Tulay CM, Yaldiz S, Bilge A. Do we really know the duration of pain after rib fracture? Kardiochir Torakochirurgia Pol. 2018;15(3):147–50.PubMedPubMedCentral
20.
21.
22.
Kim H, Lim SY, Pyon JK, Bang SI, Oh KS, Lee JE, et al. Rib-sparing and internal mammary artery-preserving microsurgical breast reconstruction with the free DIEP flap. Plast Reconstr Surg. 2013;131:327e–34e.CrossRefPubMed
23.
Porzionato A, Macchi V, Stecco C, Loukas M, Tubbs RS, De Caro R. Surgical anatomy of the pectoral nerves and the pectoral musculature. Clin Anat. 2012;25(5):559–75.CrossRefPubMed
24.
Sarhadi NS, Shaw Dunn J, Lee FD, Soutar DS. An anatomical study of the nerve supply of the breast, including the nipple and areola. Br J Plast Surg. 1996;49(3):156–64.CrossRefPubMed
25.
Hart SE, Agarwal S, Hamill JB, Brown DL. Effective treatment of chronic mastectomy pain with intercostal sensory neurectomy. Plast Reconstr Surg. 2022;149(5):876e–80e.CrossRef
26.
Spiegel AJ, Menn ZK, Eldor L, Kaufman Y, Dellon AL. Breast reinnervation: DIEP neurotization using the third anterior intercostal nerve. Plast Reconstr Surg Glob Open. 2013;1(8): e72.CrossRefPubMedPubMedCentral
27.
Maguire MF, Ravenscroft A, Beggs D, Duffy JP. A questionnaire study investigating the prevalence of the neuropathic component of chronic pain after thoracic surgery. Eur J Cardiothorac Surg. 2006;29(5):800–5.CrossRefPubMed
28.
Hivelin M, Wyniecki A, Plaud B, Marty J, Lantieri L. Ultrasound-guided bilateral transversus abdominis plane block for postoperative analgesia after breast reconstruction by DIEP flap. Plast Reconstr Surg. 2011;128(1):44–55.CrossRefPubMed
29.
30.
Tulgar S, Senturk O, Selvi O, Balaban O, Ahiskalioğlu A, Thomas DT, et al. Perichondral approach for blockage of thoracoabdominal nerves: anatomical basis and clinical experience in three cases. J Clin Anesth. 2019;54:8–10.CrossRefPubMed
31.
Abd-Elsayed A, Luo S, Falls C. Transversus abdominis plane block as a treatment modality for chronic abdominal pain. Pain Physician. 2020;23:405–12.CrossRefPubMed
32.
Pan ZY, Hu ZH, Zhang F, Xie WX, Tang YZ, Liao Q. The effect of transversus abdominis plane block on the chronic pain after colorectal surgery: a retrospective cohort study. BMC Anesthesiol. 2020;20:116.CrossRefPubMedPubMedCentral
33.
Nelson JA, Fischer JP, Pasick C, Nelson P, Chen AJ, Fosnot J, et al. Chronic pain following abdominal free flap breast reconstruction: a prospective pilot analysis. Ann Plast Surg. 2013;71(3):278–82.CrossRefPubMed
34.
Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev. 2002;3(3):141–6.CrossRefPubMed
35.
Butzelaar L, Soykan EA, Galindo Garre F, Beelen RH, Ulrich MM, Niessen FB, et al. Going into surgery: risk factors for hypertrophic scarring. Wound Repair Regen. 2015;23(4):531–7.CrossRef
36.
Montes A, Roca G, Sabate S, Lao JI, Navarro A, Cantillo J, et al. Genetic and clinical factors associated with chronic postsurgical pain after hernia repair, hysterectomy, and thoracotomy: a two-year multicenter cohort study. Anesthesiology. 2015;122(5):1123–41.CrossRef
37.
Boers N, Bleys RL, Schellekens PP. The nerve supply to the pectoralis major: an anatomical study and clinical application of the denervation in subpectoral breast implant surgery. J Plast Reconstr Aesthet Surg. 2022;75(1):415–23.CrossRefPubMed
38.
39.
40.
Andersen KG, Duriaud HM, Jensen HE, Kroman N, Kehlet H. Predictive factors for the development of persistent pain after breast cancer surgery. Pain. 2015;156(12):2413–22.CrossRefPubMed
41.
Miaskowski C, Paul SM, Cooper B, West C, Levine JD, Elboim C, et al. Identification of patient subgroups and risk factors for persistent arm/shoulder pain following breast cancer surgery. Eur J Oncol Nurs. 2014;18(3):242–53.CrossRefPubMedPubMedCentral
42.
Roth RS, Qi J, Hamill JB, Kim HM, Ballard TNS, Pusic AL, et al. Is chronic postsurgical pain surgery-induced? A study of persistent postoperative pain following breast reconstruction. Breast. 2018;37:119–25.CrossRefPubMed
43.
Nicoletti G, Mandrini S, Finotti V, Dall’Angelo A, Malovini A, Chierico S, et al. Objective clinical assessment of posture patterns after implant breast augmentation. Plast Reconstr Surg. 2015;136(2):162e–70e.CrossRefPubMed
Metadata
Title
Characteristics and distribution of chronic pain after mastectomy and breast reconstruction: a long-term prospective cohort study
Authors
Makoto Shiraishi
Yoshihiro Sowa
Itaru Tsuge
Akiko Shiraishi
Naoki Inafuku
Naoki Morimoto
Ichiro Nakayama
Publication date
31-03-2023
Publisher
Springer Nature Singapore
Published in
Surgery Today / Issue 8/2023
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-023-02676-y

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