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Cosmetic breast surgery is commonly performed in the United States; 520,000 procedures of the total 1.8 million cosmetic surgical procedures performed in 2018 were breast related. 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. 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. The anatomical distribution of chronic pain following breast augmentation procedures is dependent upon incision site placement; pectoral and intercostal nerves have been implicated. The purpose of this review is to provide an update on the current literature addressing the pathophysiology, clinical presentation, and treatment of patients presenting with chronic postoperative pain following cosmetic breast surgery.
A comprehensive literature review was performed in MEDLINE, PubMed, and Cochrane databases from 1996 to 2019 using the terms “cosmetic surgery”, “breast surgery”, “postoperative pain”, and “chronic pain”.
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.
The present review provides a discussion of clinical presentation, pathophysiology, and treatment and preventative strategies for chronic breast pain following cosmetic surgery. This review provides 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.
American Society of Plastic Surgeons. 2018 Plastic surgery statistics report. Plastic Surgery Statistics Report. 2018.
Wallace MS, Wallace AM, Lee J, Dobke MK. Pain after breast surgery: a survey of 282 women. 1996;66:195–205.
Spivey TL, Gutowski ED, Zinboonyahgoon N, King TA, Dominici L, Edwards RR, Golshan M, Schreiber KL. Chronic pain after breast surgery: a prospective. Observational study. Ann Surg Oncol. 2018;25(10):2917–24. CrossRef
van Elk N, Steegers MA, van der Weij LP, Evers AW, Hartman EH, Wilder-Smith OH. Chronic pain in women after breast augmentation: prevalence, predictive factors and quality of life. Eur J Pain. 2009;13(6):660–1. CrossRef
von Sperling ML, Høimyr H, Finnerup K, Jensen TS, Finnerup NB. Chronic postoperative pain and sensory changes following reduction mammaplasty. Scand J Pain. 2011;2(2):57–61. CrossRef
De Oliveira GS, Bialek JM, Nicosia L, McCarthy RJ, Chang R, Fitzgerald P, Kim JY. Lack of association between breast reconstructive surgery and the development of chronic pain after mastectomy: a propensity matched retrospective cohort analysis. Breast. 2014;23(4):329–33. CrossRef
Roth RS, Qi J, Hamill JB, Kim HM, Ballard TNS, Pusic AL, Wilkins EG. Is chronic postsurgical pain surgery-induced? A study of persistent postoperative pain following breast reconstruction. Breast. 2018;37:119–25. CrossRef
Wang K, Yee C, Tam S, Drost L, Chan S, Zaki P, Rico V, Ariello K, Dasios M, Lam H, Deangelis C, Chow E. Prevalence of pain in patients with breast cancer post-treatment: a systematic review. The Breast. 2018;42:113–27. CrossRef
Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457–67. CrossRef
Romundstad L, Breivik H, Roald H, Skolleborg K, Romundstad PR, Stubhaug A. Chronic pain and sensory changes after augmentation mammoplasty: long-term effects of preincisional administration of methylprednisolone. Pain. 2006;124(1–2):92–9. CrossRef
Von Sperling ML, Høimyr H, Finnerup K, Jensen TS, Finnerup NB. Persistent pain and sensory changes following cosmetic breast augmentation. Eur J Pain. 2011;15(3):328–32. CrossRef
Kaasa T, Romundstad L, Roald H, Skolleborg K, Stubhaug A. Hyperesthesia 1 year after breast augmentation surgery increases the odds for persisting pain at 4 years. A prospective four-year follow-up study. Scand J Pain. 2010;1(2):75–81.
Nikbakhsh N, Moudi S, Abbasian S, Khafri S. Prevalence of depression and anxiety among cancer patients. Casp J Intern Med. 2014;5(3):167–70.
Ng CG, Mohamed S, Kaur K, Sulaiman AH, Zainal NZ, Taib NA. Perceived distress and its association with depression and anxiety in breast cancer patients. PLoS One. 2017;12(3):1–10. CrossRef
Ducic I, Seiboth LA, Iorio ML. Chronic postoperative breast pain: danger zones for nerve injuries. Plast Reconstr Surg. 2011;127(1):41–6. CrossRef
Pace MC, Passavanti MB, de Nardis L, Bosco F, Sansone P, Pota V, Barbarisi M, Palagiano A, Iannotti FA, Panza E, Aurilio C. Nociceptor plasticity: a closer look. J Cell Physiol. 2018;233(4):2824–38. CrossRef
Fregoso G, Wang A, Tseng K, Wang J. Transition from acute to chronic pain: evaluating risk for chronic postsurgical pain. Pain Physician. 2019;22:479–88. PubMed
Reddi D, Curran N. Chronic pain after surgery: pathophysiology, risk factors and prevention. Postgrad Med J. 2014;90(1062):222–7. CrossRef
Ducic I, Zakaria HM, Felder JM, Fantus S. Nerve injuries in aesthetic breast surgery: systematic review and treatment options. Aesthetic Surg J. 2014;34(6):841–56. CrossRef
Couceiro TCDM, De Menezes TC, Valênça MM. Post-mastectomy pain syndrome. The magnitude of the problem. Rev Bras Anestesiol. 2009;59(3):358–65. CrossRef
Kokosis G, Chopra K, Darrach H, Dellon AL, Williams EH. Re-visiting post-breast surgery pain syndrome: risk factors, peripheral nerve associations and clinical implications. Gland Surg. 2019;8(4):407–15. CrossRef
Waltho D, Rockwell G. Post–breast surgery pain syndrome: establishing a consensus for the definition of post-mastectomy pain syndrome to provide a standardized clinical and research approach—a review of the literature and discussion. Can J Surg. 2016;59(5):342–50. CrossRef
Kulkarni AR, Pusic AL, Hamill JB, Kim HM, Qi J, Wilkins EG, Roth RS. Factors associated with acute postoperative pain following breast reconstruction. JPRAS Open. 2017;11:1–13. CrossRef
von Soest T, Torgersen L, Kvalem IL. Mental health and psychosocial characteristics of breast augmentation patients. J Health Psychol. 2018.
Copeland-Halperin LR, Yemc L, Emery E, Collins D, Liu C, Mesbahi AN, Venturi ML. Evaluating postoperative narcotic use in prepectoral versus dual-plane breast reconstruction following mastectomy. Plast Reconstr Surg Glob Open. 2019;7(2):e2082. CrossRef
Gassman AA, Yoon AP, Festekjian J, Da Lio AL, Tseng CY, Crisera C. Comparison of immediate postoperative pain in implant-based breast reconstructions. J Plast Reconstr Aesthetic Surg. 2016;69(5):604–16. CrossRef
Broyles J, Tuffaha S, Williams E, Glickman L, George T, Dellon AL. Pain after breast surgery: etiology, diagnosis, and definitive management. Microsurgery. 2016;36(7):535–8. CrossRef
Chopra K, Kokosis G, Slavin B, Williams E, Dellon AL. Painful complications after cosmetic surgery: management of peripheral nerve injury. Aesthetic Surg J. 2018;1–9
Temple-Oberle C, Shea-Budgell MA, Tan M, Semple JL, Schrag C, Barreto M, Blondeel P, Hamming J, Dayan J, Ljungqvist O, ERAS Society. Consensus review of optimal perioperative care in breast reconstruction: Enhanced Recovery After Surgery (ERAS) Society recommendations. Plast Reconstr Surg. 2017;139(5):1056e–1071e.
Thapa P, Euasobhon P. Chronic postsurgical pain: current evidence for prevention and management. Korean J Pain. 2018;31(3):155–73. CrossRef
Mishriky BM, Waldron NH, Habib AS. Impact of pregabalin on acute and persistent postoperative pain: a systematic review and meta-analysis. Br J Anaesth. 2015;114(1):10–31. CrossRef
Martinez V, Pichard X, Fletcher D. Perioperative pregabalin administration does not prevent chronic postoperative pain: systematic review with a meta-analysis of randomized trials. Pain. 2017;158(5):775–83. CrossRef
Larsson IM, Ahm Sørensen J, Bille C. The post-mastectomy pain syndrome—a systematic review of the treatment modalities. Breast J. 2017;23(3):338–43. CrossRef
Riediger C, Schuster T, Barlinn K, Maier S, Weitz J, Siepmann T. Adverse effects of antidepressants for chronic pain: a systematic review and meta-analysis. Front Neurol. 2017;8:307. CrossRef
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA J Am Med Assoc. 2016;315(15):1624–45. CrossRef
Massingill J, Jorgensen C, Dolata J, Sehgal AR. Myofascial massage for chronic pain and decreased upper extremity mobility after breast cancer surgery. Int J Ther Massage Bodyw Res Educ Pract. 2018;11(3):4–9.
Zinboonyahgoon N, Vlassakov K, Lirk P, Spivey T, King T, Dominici L, Golshan M, Strichartz G, Edwards R, Schreiber K. Benefit of regional anaesthesia on postoperative pain following mastectomy: the influence of catastrophising. Br J Anaesth. 2019;123(2):e293–302. CrossRef
Hussain N, Shastri U, McCartney CJL, Gilron I, Fillingim RB, Clarke H, Katz J, Juni P, Laupacis A, Wijeysundera D, Abdallah FW. Should thoracic paravertebral blocks be used to prevent chronic postsurgical pain after breast cancer surgery? A systematic analysis of evidence in light of IMMPACT recommendations. Pain. 2018;159(10):1955–71. CrossRef
Leiman D, Barlow M, Carpin K, Piña EM, Casso D. Medial and lateral pectoral nerve block with liposomal bupivacaine for the management of postsurgical pain after submuscular breast augmentation. Plast Reconstr surgery Glob open. 2014;2(12):e282. CrossRef
Kulhari S, Bharti N, Bala I, Arora S, Singh G. Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial. Br J Anaesth. 2016;117(3):382–6. CrossRef
Wang K, Zhang X, Zhang T, Yue H, Sun S, Zhao H, Zhou P. The efficacy of ultrasound-guided type II pectoral nerve blocks in perioperative pain management for immediate reconstruction after modified radical mastectomy. A prospective, randomized study. Clin J Pain. 2017;1.
Unkart JT, Padwal JA, Ilfeld BM, Wallace AM. Treatment of post-latissimus dorsi flap breast reconstruction pain with continuous paravertebral nerve blocks: a retrospective review. Anesthesiol pain Med. 2016;6(5):e39476. CrossRef
Oh J, Pagé MG, Zhong T, McCluskey S, Srinivas C, O’Neill AC, Kahn J, Katz J, Hofer SOP, Clarke H. Chronic postsurgical pain outcomes in breast reconstruction patients receiving perioperative transversus abdominis plane catheters at the donor site: a prospective cohort follow-up study. Pain Pract. 2017;17(8):999–1007. CrossRef
Batdorf NJ, Lemaine V, Lovely JK, Ballman KV, Goede WJ, Martinez-Jorge J, Booth-Kowalczyk AL, Grubbs PL, Bungum LD, Saint-Cyr M. Enhanced recovery after surgery in microvascular breast reconstruction. J Plast Reconstr Aesthetic Surg. 2015;68(3):395–402. CrossRef
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. CrossRef
Zocca JA, Chen GH, Puttanniah VG, Hung JC, Gulati A. Ultrasound-guided serratus plane block for treatment of postmastectomy pain syndromes in breast cancer patients: a case series. Pain Pract. 2017;17(1):141–6. CrossRef
Kim HT, Kim KY, Kim YD, Moon HS. Pulsed radiofrequency lesioning for treatment of chronic breast neuropathic pain after breast reduction—a case report. Korean J Anesthesiol. 2010;59(Suppl):S238–41. CrossRef
- Chronic Pain Following Cosmetic Breast Surgery: A Comprehensive Review
Anh L. Ngo
Richard D. Urman
Alan D. Kaye
- Springer Healthcare
Pain and Therapy
Print ISSN: 2193-8237
Elektronische ISSN: 2193-651X
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