Nerve pain

Did you ever figure this out? I am having pain as well 5 years out.

According to the best estimates in the literature, around 25-30% of women have chronic or recurring pain after breast surgery, mostly of a neuropathic origin. I've been stunned that neither of the first two surgeons I consulted with were aware of how common this is, and neither believed me when I told them the published numbers. They both claimed it was not longer a problem. Suffice it to say that neither was familiar with modern surgical techniques for minimizing this risk.

Meanwhile, back in reality, there is an entire chain of clinics here that specialize in treating post-mastectomy pain syndrome (AKA post breast surgery pain syndrome). https://info.advancedreconstruction.com/post-mastectomy-pain?gclid=CjwKCAjwi8iXBhBeEiwAKbUofUPWkpNP0-Qt3rzzy1eQrsMHNFiMzIswu_YzWxjeSj-LhHAYoL5tfBoChgYQAvD_BwE It is treatable.

A savvy breast surgeon or neuropathic pain specialist should be able to use nerve blocks to determine exactly which nerve branch is causing your pain, and make an educated guess as to why--whether it might be entrapped or compressed, or whether it would have been severed or accidentally injured during surgery. In general, the recommendations will be to start conservatively and escalate if the problem persists. So...

1. You would typically start with topical pain relievers and physical therapy. PT can be especially helpful if the nerve has become compressed or entrapped.

2. Then they might try oral agents like gabapentin and anti inflammatories.

3. After that, they might try long-acting nerve blocks.

4. Depending on what the likely problem is, they may try minimally invasive procedures like fat injections, which kind of "insulate" and calm down inflamed nerves.

5. At the extreme end of the spectrum, if nothing else has worked, they can do an remediation surgery. They explore the area, and generally find that the cut end of a nerve has formed a painful, abnormal structure called a neuroma. This can be removed and the nerve end can be handled in a number of different ways to prevent recurrence. It can be grafted into a nearby motor nerve, which makes the cut nerve think it's whole again, but has no effect on muscle function. It can be buried in muscle tissue in such a way that it stops "freaking out". Or it can be capped with a special membrane.These are all microsurgical techniques that are routinely used in amputations now. I don't know why the breast surgery world seems to be so slow in adopting these measures for breast amputations, but it's certainly of consistent with all the studies showing physicians take women's pain less seriously than men's.

Please don't wait to get help. The longer you are in pain, the more it changes your central nervous system, sensitizing you to pain in general and making it harder to treat. The sooner you treat it, the better your chance of success.