Persistent Pain After Mastectomy: Analysis Of The Impact Of Breast Reconstruction
Justin Broyles, Doctor of Medicine1, Sigurast S. Olafsson, Bachelor of Science2, Jason Clain, Doctor of Medicine1, K Mikayla Flowers, Master of Science3, Erin Taylor, Doctor of Medicine1, Jessica Erdmann-Sager, Doctor of Medicine1, Kristin L. Shreiber, Doctor of Medicine, Doctor of Philosophy3.
1Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, USA, 2Harvard Medical School, Boston, MA, USA, 3Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Introduction: Whether or not to undergo reconstruction following mastectomy may be a difficult decision for a patient to make. Determining whether there are lasting differences in psychosocial and pain outcomes following mastectomy with or without reconstruction is essential for reconstructive surgeons to adequately set expectations and appropriately counsel patients. Most prior studies are limited by being retrospective in nature, lacking complete follow up, and using less sensitive metrics for investigating these outcomes.
Methods: This prospective, observational, single center study used validated questionnaires to assess psychological and pain outcomes over 12 months after surgery. 123 patients undergoing mastectomy were assessed pre-operatively and at 14 days, 3, 6, and 12 months post-operatively. Independent sample t-tests were used to determine baseline differences between groups and differences in outcomes at each timepoint.
Results: 123 patients undergoing mastectomy were included in the study. 34 patients received no reconstruction and 89 patients received reconstruction. Patients who underwent reconstruction were younger (49 years vs 58 years, p=0.001) and had longer duration of surgery (257 minutes vs 132 minutes, p<0.001). There were no group differences in chemotherapy, radiation, nodal surgery, or baseline anxiety, depression, or Pain Catastrophizing Scores (PCS).
On post-operative day 1, patients with reconstruction reported significantly higher Numeric Rating Scale (NRS) pain scores. However other pain outcomes, including Pain Severity Index, neuropathic pain score, cognitive and emotional impact of surgical area pain, or physical impact of surgical area pain, as measured by the Breast Cancer Pain Questionnaire (BCPQ) were not different between these 2 groups at any later timepoint.
Conclusion: Overall, this prospective study with rigorous and frequent follow-up suggest that reconstruction was not associated with greater long-term pain severity or impact during the first postoperative year. Certain other patient factors may be associated with greater risk of persistent pain (greater somatization, baseline sleep disturbance, baseline pain, and ALND) (Schreiber et al., 2021). Taken together, this information can be used to help individual patients weigh options following mastectomy.
References: 1.Schreiber, K. L., Zinboonyahgoon, N., Flowers, K. M., Hruschak, V., Fields, K. G., Patton, M. E., Schwartz, E., Azizoddin, D., Soens, M., King, T., Partridge, A., Pusic, A., Golshan, M., & Edwards, R. R. (2021). Prediction of Persistent Pain Severity and Impact 12 Months After Breast Surgery Using Comprehensive
Preoperative Assessment of Biopsychosocial Pain Modulators. Annals of surgical oncology, 28(9), 5015–5038. https://doi.org/10.1245/s10434-020-09479-2
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