Pain in the Breast: A Comprehensive Review of Chronic Pain Following Cosmetic Breast Surgery

As one of the co-authors, Dr. Anh Ngo in collaboration with our research group from leading U.S. academic institutions recently compiled and published in Pain and Therapy Journal a comprehensive review of chronic pain following cosmetic breast surgery.  The research team provided the review as an update on the current literature addressing the pathophysiology, clinical presentation, and treatment of patients presenting with chronic postoperative pain following cosmetic breast surgery.

Introduction

Our writing team reported that cosmetic breast surgery is commonly performed in the United States with 520,000 procedures of the total 1.8 million cosmetic surgical procedures performed in 2018 were breast related. Our research group also discussed that postoperative chronic pain, defined as lasting 3 or more months, has been reported in a wide variety of breast surgical procedures including breast augmentation, reduction mammaplasty, mastectomy, and mastectomy with reconstruction. They found that patient characteristics associated with the development of postoperative chronic pain following cosmetic breast surgery include a younger age, larger BMI, smaller height, postoperative hyperesthesia, and elevated baseline depression, anxiety, and catastrophizing scores. Furthermore, the group reported that anatomical distribution of chronic pain following breast augmentation procedures is dependent upon incision site placement; pectoral and intercostal nerves have been implicated.

Our Methods

Our research group performed a comprehensive literature review in MEDLINE, PubMed, and Cochrane databases from 1996 to 2019 using the terms "cosmetic surgery", "breast surgery", "postoperative pain", and "chronic pain".

Our Results

From the review, our research team found the following:

• Cosmetic breast surgery can have a similar presentation as post-mastectomy pain syndrome and thus have overlapping diagnostic criteria.
  
  
• Seven domains are identified for a diagnosis of PBSPS:
  • Pain after breast surgery,
  • neuropathic in nature,
  • at least a moderate intensity of pain,
  • as defined as within the middle one-third of the selected pain scale,
  • pain for at least 6 months, symptoms occurring for 12 or more hours a day for a minimum of 4 days each week,
  • pain in at least one of the following sites: breast, chest wall, axilla, or arm on the affected side,
  • pain exacerbated by movement.
    
    
• Patient risk factors and surgical risk factors may influence the development of chronic post-cosmetic surgery breast pain.
  
  
• Improved perioperative analgesia including preoperative regional nerve anesthesia and postoperative catheter infusion have been shown to improve chronic postoperative pain outcomes.
  
  

Our Conclusions

Our research team provided in this review a discussion of clinical presentation, pathophysiology, and treatment and preventative strategies for chronic breast pain following cosmetic surgery. This review provided evidence from multiple randomized controlled trials (RCTs) and systematic reviews of efficacy and effectiveness. While chronic postoperative breast pain remains challenging to treat, various preventative strategies have been described to improve postoperative pain outcomes.

To find out if you can benefit from any of existing therapies for pain following cosmetic breast surgery, contact Pain Specialty Group by phone or request an appointment online today.

For a copy of the article, click here.

KEYWORDS:

Breast augmentation; Breast surgery; Chronic pain; Cosmetic surgery; Mammaplasty; Mastectomy; Reduction

Author

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