A mastectomy is a major operation. Most women who brave this procedure experience some pain, known as postmastectomy pain, or simply mastectomy pain (MP). The Mayo clinic reports that 20 percent to 60 percent of women who undergo breast surgery develop pain. MP can come on immediately or months after the surgery. It can be chronic and last for several months. The extent of MP varies from mild to severe enough to interfere with normal life, depending on each woman’s individual operation and tolerance for pain. And, for many women, psychological pain accompanies the physical pain.
Women have described mastectomy pain as a dull ache, a burning feeling, a numbness, an itching, or a tingling sensation. Intense MP can emerge quickly for no apparent reason. Mild pain can be aggravated by the slightest pressure. Mastectomy pain shows up anywhere in the chest area, the armpit, or arm on the side of the body the breast was operated on.
There are three major causes of postmastectomy pain: a seroma; a condition called post-mastectomy pain syndrome; and adhesions.
A seroma is a collection of fluid, called serous fluid, that often occurs after surgery (not only a mastectomy) or following an injury. Fluid leaks from damaged blood vessels, lymph vessels, and tissue under the skin around the surgical wound. A mastectomy leaves empty spaces under the skin where a kind of blister can form to contain the leaking fluid. A seroma is the most common cause of postmastectomy pain. When the seroma is small, usually no treatment is necessary. But it needs to be monitored. A seroma that continues to grow and is left untreated can lead to serious complications.
Postmastectomy Pain Syndrome
Postmastectomy pain syndrome (PMPS) is sometimes used as a general term for MP. But, more specifically, PMPS refers to MP caused by nerve damage. In some cases, nerves in the breast or underarm area are damaged during a mastectomy. And sometimes following a mastectomy, an abnormal growth of tissue, called a neuroma, develops. (Neuromas develop after other types of surgeries as well.) Neuromas are usually benign. But as the abnormal tissue grows and thickens, it can cause serve nerve pain.
After mastectomy surgery (or any kind of surgery), adhesions, also called scar tissue, form along the surgical wound. This is the body’s normal response and the first step in healing. The scar tissue, however, sometimes becomes abnormally thick, which can lead to pain, inflammation, and restriction of the arm’s normal range of motion. This restricted motion can lead to another painful condition known as frozen shoulder.
Treatments for Mastectomy Pain
Whatever the cause, treatment for MP usually begins with medications: nonsteriodial anti-inflammatory drugs such as aspirin and ibuprofen, and ointments and balms to treat pain; antibiotics to treat any possible infection; and antidepressants if necessary.
The next step in treatment depends on the cause of the MP. Seromas can be drained, usually a minor procedure, to provide relief. Neuromas and adhesions are effectively treated with specialized physical therapy, such as the Wurn Technique, that breaks down and flushes away abnormal tissue growth. Massage, however, unless expertly done, is often painful around sensitive surgical wounds, especially in the breast area.
Surgery is usually the last resort for mastectomy pain. Surgeons can remove seromas or adhesions. Unfortunately, additional surgeries often lead to the growth, again, of seromas or adhesions, and an unwanted cycle of surgeries begins for the mastectomy patient.