How do you assess and counsel women with chronic post-lumpectomy or mastectomy pain?

Post-surgical breast pain is not uncommon. Estimates suggest that 25-60% of patients having breast surgery experience persistent pain, with symptoms lasting from months to years following breast cancer diagnosis and treatment (Langford et al., PMID 25439318; Gartner et al., PMID 19903919).

Initial assessment should include a careful history and physical exam, assessing the pain severity, risk factors, and ruling out an anatomical cause for the pain. Physical therapy, to assess for breast lymphede...

In my experience, the single most frequent cause of locoregional pain following breast surgery is axillary cording. This is seldom recognized but quite common after mastectomy or BCS, when nodal sampling has been performed, even SLNB. I screen for this prior to simulation and perform a gentle release in the office if detected. This makes the positioning for radiation treatments much more tolerable.

Cording can also be a chronic and functionally debilitating problem, causing significant pain with...

In my experience, post-lumpectomy/post-radiation breast pain is most often due to underlying rib tenderness with no actual breast tenderness. Imaging is usually negative. The basis for the tenderness may be a mild degree of radiation-induced osteitis costae. This may well resolve over time with conservative measures. It is possible that more severe cases could benefit from hyperbaric oxygen therapy, although I have no experience of using this modality.

Occasionally, a patient may be found to hav...