Characterization of post-mastectomy pain syndrome in breast cancer patients undergoing subsequent reconstruction: A scoping review

Background

25–60% of mastectomy patients experience chronic pain, known as post-mastectomy pain syndrome (PMPS). However, there is a lack of consensus about the timeline and definition of PMPS. As mastectomy followed by breast reconstruction is commonly utilized by patients with breast cancer, how we define and diagnose PMPS will play a critical role in managing these patients. This review presents the scope of literature about chronic pain in breast cancer patients who received mastectomy and subsequent reconstruction.

Methods

Six databases were searched for articles about breast cancer patients undergoing mastectomy and reconstruction who experienced chronic pain. Details about pain and reconstruction type were extracted. Chronic pain definitions were analyzed descriptively.

Results

Thirty-six articles described 6906 patients (mean age 48.2 years) who underwent mastectomy and reconstruction between 1996 and 2022. Overall, 47% of patients experienced chronic pain. Six studies defined chronic pain, with one listing symptoms and four mentioning (but not specifying) pain duration. Eleven studies reported time to pain presentation, ranging from 1.3 to 94 months post-surgery. Of the eight that specified etiology, seven were limited to neuropathic pain, while one described musculoskeletal pain. Among patients for whom reconstruction type was specified, 54% of those with implant-based reconstruction (n=1336/2469) reported chronic pain, compared to 47% of those with autologous reconstruction (n=508/1077; p<0.001).

Conclusion

Chronic pain can be an unfortunate, multifactorial complication of mastectomy and breast reconstruction. With mastectomy and subsequent reconstruction being a common option for breast cancer management, it is imperative to comprehensively characterize PMPS and its relationship with breast reconstruction.