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Medically Reviewed By:

Dr. Amanda Olson, DPT, PRPC
President & Chief Clinical Officer

What You Should Know About Post Mastectomy Pain Syndrome

While most women experience some level of nerve pain in the chest wall, armpit, or shoulder during the weeks following a mastectomy, it is not normal for pain to linger for more than a few months.

When it does, it’s referred to as Post Mastectomy Pain Syndrome (PMPS). PMPS can occur after a radical mastectomy, a modified radical mastectomy, or a lumpectomy.

Read on, to learn everything you should know about post-mastectomy pain syndrome. 

Symptoms of Post Mastectomy Pain Syndrome

The most common symptoms of post-mastectomy pain syndrome include a tingling pain in the chest, arm, shoulder, or armpit that either persists or comes and goes for months, sometimes years after surgery. Some women also experience numbness, shooting pain, a burning sensation, or severe itching around the surgical site that cannot be relieved.  

Over time, this type of pain around the chest, underarm, or shoulder can lead to favoring one arm over the other. Failing to use one arm properly could result in a condition called frozen shoulder and also heighten the risk of lymphedema, where lymphatic fluids fail to drain and cause uncomfortable swelling in the arm.  

Furthermore, when this type of pain persists over an extended period, insomnia can set in, resulting in a weaker immune system and greater susceptibility to other illnesses.   

Is Post Mastectomy Pain Syndrome Common?

According to studies, 20%-30% of women who undergo a mastectomy or lumpectomy suffer from PMPS after their surgery. It is also believed to be more common following procedures in the underarm or upper outer chest area.   

Additionally, women who have undergone a full axillary lymph node dissection (ALND), or received radiation treatment or chemotherapy after surgery, are believed to be more vulnerable to PMPS. 

What Causes Post Mastectomy Pain Syndrome?

While the cause of PMPS is not yet fully understood, researchers think it’s linked to nerve changes during surgery. The nipple, areola, and breast tissue are home to a myriad of nerves, some of which can be altered during a mastectomy to remove a tumor and surrounding tissue. 

This type of nerve damage is believed to be the source of PMPS, but is yet to be proven.     

Post-Mastectomy Pain Syndrome: Treatment Options 

Should you continue to feel pain several months after breast surgery, the first thing to do is schedule an appointment with your doctor to identify the source of the pain.   

Shoulder Pain

Shoulder pain, depending on the extent of discomfort, can be treated by working with a physical therapist and regular exercises to improve flexibility and range of motion. If frozen shoulder has already set in, your doctor may recommend a visit to an orthopedist.     

Lymphedema

Lymphedema, where lymphatic fluids in the underarm fail to drain and cause uncomfortable swelling in the arm, does not currently have a cure. However, it can be managed through specialized massage and exercises which encourage lymphatic fluid to flow more easily. Compression therapy, or compression sleeves for the arm, also promote the flow of lymph fluid. 

Nerve Pain

Nerve pain is initially treated with physical therapy, exercises, and sometimes over-the-counter pain medication.  

Insomnia

It is also important to speak with your doctor if your pain is interrupting your sleep to the point that it affects your everyday life. Sleeping is a vital component of a healthy lifestyle and lack of it not only slows the healing process it also weakens your immunity and can result in additional illnesses.

Overall Wellness

Like most conditions, maintaining a good level of overall wellness is hugely significant to help manage the pain associated with PMPS. Ensuring you eat a nutritious diet of whole foods, vegetables, and fruit, as well as getting some regular gentle exercise, will not only help you to feel more positive during the day, it will also encourage better sleep at night.  

Alternative Therapies

Alternative therapies that help to treat PMPS include acupuncture, massage, relaxation techniques like meditation, and transcutaneous nerve stimulation. 

Post-Mastectomy At-Home Management Tips

Follow Advice

After a mastectomy or lumpectomy, it is incredibly important to follow your surgeon’s advice for recuperation and to report any or all side affects you experience. Try not to worry about returning to your usual chores or routines and instead allow yourself adequate time to heal and recover. Rushing the healing process will only result in setbacks and a longer recovery time. 

Slow & Steady Movement

Even though it’s difficult to even think about moving when in pain after surgery, it is crucial to gently move the shoulders and arms a few times a day post-mastectomy. Gentle movement in the first few days of recovery will prevent stiffness and frozen shoulder from setting in, as well as promote flexibility and avoid lymphedema. 

Self-Massage

Your surgeon will also show you how to massage the area surrounding the scar as soon as all bandages and surgical drains are removed. This type of massage promotes a softening of the tissue around where the incision was made and soothes tender muscles.  

No Bra or Prosthesis

Even though you might be keen to start wearing a bra or a prosthesis after breast surgery, it is better to wait for the go-ahead from your doctor. The surgical site will need time to heal and strengthen after the operation and the skin surrounding the incision will also feel sensitive to touch for a few weeks, making any contact with the tightness of a bra or the touch of a prosthesis quite uncomfortable. 

Conclusion

Pain after a mastectomy or lumpectomy does not mean the cancer has returned nor does it necessarily mean that something bad happened during surgery. If you experience persistent pain or pain that comes and goes several months after surgery, schedule an appointment with your doctor for further investigation. 

If left untreated, post-mastectomy pain syndrome can result in losing the ability to move your arm properly, as well as cause other illnesses due to lack of sleep and lowered immunity. However, when diagnosed early, your doctor can prescribe pain medication and treatment options to manage and improve the condition over time. 

References

Cancer.Org – Post-Mastectomy Pain Syndrome - https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/pain/post-mastectomy-pain-syndrome.html

BreastCancer.Org - Mastectomy, What To Expect - https://www.breastcancer.org/treatment/surgery/mastectomy/expectations

Mayo Clinic – Expert Answers, Pain After Breast Surgery - https://www.mayoclinic.org/tests-procedures/mastectomy/expert-answers/pain-after-breast-surgery/faq-20058049

Johns Hopkins Medicine – Treating Lymphedema - https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/treating-lymphedema