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Post-mastectomy pain syndrome, or PMPS, refers to lingering pain in the chest wall, armpit, or arm following a mastectomy and other breast-conserving surgeries. Between 20 and 40 percent of post-mastectomy patients develop PMPS after surgery.
Symptoms & Treatment for Post-Mastectomy Pain Syndrome (PMPS)
What is PMPS?
Symptoms
Post-mastectomy pain is often described as burning, aching, or shooting. While most women report that their PMPS symptoms are mild, it’s still a condition that may require daily self-care and treatment.
Causes
Experts believe that post-mastectomy pain syndrome results from nerves damaged during breast surgery. Nerve damage is a common side effect of surgery, often resulting in pain and loss of sensation that can manifest long after other surgical effects have subsided. Some patients will experience post-mastectomy pain immediately following breast surgery, while others may not develop symptoms of post-mastectomy pain syndrome until weeks or even months after surgery.
Risk Factors
There are several factors that may increase the risk of developing PMPS, including:
- Age: Older people may be more at risk for developing PMPS as the risk of chronic pain increases with age.
- Type of surgery: PMPS is more likely to occur after a mastectomy than after a breast-conserving surgery (such as a lumpectomy).
- Cancer type: People with certain types of breast cancer, such as inflammatory breast cancer, may be more at risk for developing PMPS.
- Previous history of chronic pain: People who have a history of chronic pain, such as back pain or headaches, may be more at risk for developing PMPS.
- Pre-existing nerve damage: People with pre-existing nerve damage, such as from diabetes, may be more at risk for developing PMPS.
- Psychological factors: People who experience high levels of stress or anxiety after surgery may be more at risk for developing PMPS.
Diagnosing
To diagnose PMPS, a healthcare provider will typically perform a physical examination and review the patient's medical history. They may also ask the patient to describe the location and intensity of their pain, as well as any other symptoms they are experiencing. In some cases, additional tests may be needed to diagnose PMPS, including:
- Imaging tests: X-rays, CT scans, or MRI scans may be used to evaluate the breasts and surrounding tissues for any abnormalities or injuries that may be causing the pain.
- Nerve conduction studies: These tests measure the speed and strength of nerve signals to help determine if there is any nerve damage.
- Psychological evaluation: A mental health professional may be consulted to assess the patient's mental health and evaluate the impact of psychological factors on the pain.
Surgical Treatments for Post-Mastectomy Pain Syndrome
If non-surgical conservative methods have failed to improve your pain and arm mobility, our renowned experts provide advanced nerve surgery procedures. Depending on the extent of an individual's nerve damage, we provide the following solutions:
- Autologous fat grafting, a procedure where fat from other areas of the body is grafted to the breast area to provide additional cushioning and anti-inflammatory benefits.
- Nerve grafting, where a piece of "donor" nerve is taken from another area of the body and used to bridge a gap between two nerve ends.
- Nerve repair, where we surgically reconnect the ends of a damaged nerve.
- Nerve transfer, where a healthy nerve is rerouted and connected to a nearby damaged nerve, restoring function and sensation.
- Neurolysis, a procedure to remove scarring from an injured nerve to encourage nerve growth.
Additionally, we offer breast reconstruction surgery for patients who may be interested in restoring the shape and volume to their breasts at the same time as a PMPS procedure.
Typically nerve surgery is an outpatient procedure performed under general anesthesia. Nerve endings grow at a rate of approximately one inch per month, so it can take some time for you to fully recover after a nerve surgery.
Our team will be sure to schedule follow-up appointments to determine how your nerves are regenerating. Expect to participate in physical therapy during the recovery period to keep your nerves, muscles, and tendons active and flexible.
Non-Surgical Treatments for Post-Mastectomy Pain Syndrome
For patients who are not ideal candidates for surgery or wish to avoid another surgical procedure, Dr. Nicole Ferro, our fellowship-trained interventional pain management specialist, offers a range of advanced, minimally invasive treatments to relieve PMPS symptoms and enhance quality of life, including:
- Amniotic Tissue Injectables: Promotes nerve healing and reduces inflammation.
- Botox Injections (Ultrasound-Guided): Helps relax tight pectoral muscles contributing to pain.
- Intercostal Nerve Blocks with Steroids: Provides temporary pain relief by calming inflamed nerves.
- Physical Therapy & Topical Creams: A multimodal approach to desensitizing affected areas.
- Radiofrequency Ablation: A longer-lasting option that interrupts pain signals at the nerve level.
For many patients, these non-surgical options provide significant relief, allowing them to focus on recovery and return to the activities they love.
Am I a Candidate for Non-Surgical PMPS Treatment?
If you’re experiencing persistent pain after a mastectomy but are hesitant about additional surgery, non-surgical treatments may be a viable option. Non-surgical treatment may be recommended for patients who:
- Have a high surgical risk due to conditions such as heart disease, diabetes, or autoimmune disorders.
- Experience poor wound healing potential from smoking, poor circulation, or prior radiation therapy.
- Have a history of adverse reactions to anesthesia and need alternatives to avoid complications.
- Suffer from episodic rather than constant pain that does not significantly disrupt daily activities.
- Have fear or anxiety about additional surgery and prefer a conservative approach.
- Experience post-traumatic stress from previous surgeries or cancer treatments, making surgical intervention emotionally distressing.
Our Surgeons
The surgical team at The Institute for Advanced Reconstruction are leaders in the fields of nerve surgery to treat the side effects of cancer treatments, including PMPS, lymphedema, and chemotherapy-induced neuropathy. Our patients come from all over the world for our cutting-edge surgical techniques and expertise in these fields.
Our experts in PMPS include:
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Insurance Information
The Institute for Advanced Reconstruction participates in a wide range of insurance plans, including those listed below. However, each physician has their own accepted insurance and hospital affiliations. Before scheduling an appointment, please contact your insurance carrier to confirm that your provider is in-network.
If we are not an in-network provider, our friendly insurance specialists will help you find the most coverage available for your treatment.
- Horizon Blue Cross Blue Shield of New Jersey
- Medicare
- Railroad Medicare
- Aetna
- Cigna
- United Healthcare
- Oxford (Freedom, Liberty)
- MagnaCare
Patient Resources
Learn more about what to expect when it comes to surgical procedures and treatments at the Institute for Advanced Reconstruction by visiting our patient resource page.
Am I a candidate for nerve surgery?
Don’t let chronic post-surgical pain or loss of sensation keep you from moving forward after a mastectomy. Schedule an appointment today to find out if our advanced nerve surgery procedures are an option for you.