A Personal Reflection by Elizabeth Vivenzio, President of BreastHealing.com

Pain after mastectomy is a harsh reality for many women; studies have shown that nearly half of all post-mastectomy women live with some degree of pain. Although it is mild for some, a significant number have debilitating pain that can lead to a diminished lifestyle, disability and/or long-term dependence on pain medications.

Post-Mastectomy Pain Syndrome Defined

Post-Mastectomy Pain Syndrome Defined
Post-Mastectomy Pain Syndrome (PMPS) is diagnosed in women with ongoing pain and muscle tightness in the chest wall, shoulder, arm or underarm. The pain of PMPS is attributed to inflammation along the intercostal-brachial nerve, a peripheral nerve leading to tributaries that branch into the armpit and upper arm. Pain, numbness and burning can result.

Commonly Recognized Causes of Post-Mastectomy Pain

Some of the commonly recognized causes of post-mastectomy pain include:

Neurological:

  • Nerves can be damaged from surgical incisions and result in inflammation and irritation. This can cause shooting pains which may be temporary; but, there is no guarantee that the nerves will recover from the trauma of surgery.
  • Neuromas results from trauma to nerves, usually during a surgical procedure. The affected nerves bundle up into a ball of scar tissue and form a painful, benign tumor.

Lymphatic:

  • Lymphedema results if lymph fluid is blockedand cannot drain properly. It occurs in some cases after lymph node removal or following radiation. Swelling induces pain and discomfort, which can occur after mastectomy in the arms or trunk of the body.

Muscular:

  • Capsular contracture is when the pocket around the implant begins to hardenand squeeze the implant, causing pain, pressure and distortion.
  • Painful inflammation can occur from distortedmuscular biomechanics of the area when expanders and/or implants are placed under the pectoral muscle. This is a cause that is rarely discussed in medical literature (aside from capsular contracture). The medical community assures women that the pectoral muscles will naturally stretch to accommodate the expanders and implants. However, this is not always the case.  Every muscle that is attached to the pectoral is affected when it is manipulated, moved and pushed to accommodate the expander and/or implant.In some cases the pain becomes so intense that women decide to deconstruct…they have the offending implants removed to be free of the pain.  (Read more about Breast Deconstruction.)

Muscle pain from expanders and under-muscle implants often manifests as:

  • shoulder pain, which can be complicated by inflammation (tendonitis and frozen shoulder syndrome)
  • tightness and pain in the pectoral muscles
  • searing pain in any of the numerous muscles connected to the pectoral including, but not limited to, the serratus anterior, which attaches from the front of your ribs and curves around to your shoulder blade
  • pain in the chest, sternum and ribs
  • neuromas from constant nerve inflammation.

Breast Cancer Treatment:

  • Radiation may cause implant pain if it results in skin hardness and scarring that causes tightness around the implant site.
  • Certain medications cause joint and muscle pain.

Awareness Needed that SIZE MATTERS in Reducing Risk of Pain

A Commentary by Elizabeth Vivenzio…

Both patients and physicians need awareness and education that,“Bigger is NOT Better.” Breast Healing’s SIZE MATTERS Awareness Campaign encourages the discussion of implant size decisions during breast reconstruction. The contention of the SIZE MATTERS message is that the larger the implant, the greater the risk of post-mastectomy pain, discomfort and other complications from the distorted biomechanics of the pectoral and surrounding muscles.

Surgeons Can Exacerbate this Situation

Women look to their surgeons for guidance when it comes to size. They assess the size of the circumference of the woman’s chest, size of her frame, and weight.  Unfortunately for larger, heavier women, they sometimes encourage larger implants than the muscles can accommodatebecause they have an optimal goal of making a woman appear moresymmetrical with their hips or stomachs.

Surgeons do not gain a perspective on implant pain because they often do not see patients long-term after their reconstructions. It is my contention that it is a disservice to women to assume that they need larger implants to be content with their reconstructions. Many a large woman would be happy with small, rounded A-Cup breasts if the alternative was pain with a larger size. It is a shame that we are misinformed about this risk, and it leads to women seeking larger sizes themselves.

Without full disclosure about pain complications that can occur with distorted biomechanics of the area muscles, women of all shapes and sizes opt for going bigger. I have heard and read statements from women who say things like:

“If I have to have a mastectomy and get reconstruction, then I want bigger boobs.”
“I was going to go for a B, but my husband really wants a C.”
“Since I have been small-breasted all my life, now is the time for me to finally get my big boobs.”

I observed a woman on a private Facebook page flaunt her double D’s on a small frame. The photo made me wince as I saw her muscular biomechanics visibly distorted and stretched to the limit. Three months later, she shared photos of the complication of the implant breaking through her skin. She lost the implant due to this complication.

The Pulse of Post-Mastectomy Pain in Social Media

Although not often recognized in medical literature, Social Media is abuzz with women who are in muscular discomfort from their under-pectoral implants. Women share real-time stories of living in unremitting pain that leads to a poor quality of life, limited activities, and, sadly, a vicious cycle of narcotic medications. Some write about living on three different types of pain medications, along with medications for the anxiety and depression that comes along with chronic pain. Relationships suffer; marriages fail; lives are ruined. The stories are heartbreaking.

If you wish to participate in our SIZE MATTERS Awareness Campaign , please use our share buttons to empower others on this critically important information.

Treatment Options for Painful Implants

Breast Rehabilitation

Mastectomy Massage

Warm Compresses/Stretching Exercises

Topical Anesthetic Ointments

Pain Medications and Patches

Final Resort: Breast Deconstruction: Freedom from the Pain