Effective Treatment of Chronic Mastectomy Pain with
Intercostal Sensory Neurectomy
by Hart, Sarah E.; Agarwal, Shailesh; Hamill, Jennifer B.;
Brown, David L.
Plastic and Reconstructive Surgery: May 2022 -
Volume 149 - Issue 5 - p 876e-880e
Chronic postmastectomy pain affects up to 40 percent of
patients and leads to diminished quality of life and increased risk of opioid
dependence. The cause of this pain is incompletely understood; however, one
hypothesis is that direct injury to cutaneous intercostal nerves at the time of
mastectomy and/or reconstruction leads to chronic pain. As a result, proximal
neurectomy of the involved sensory nerve(s) has been suggested to be effective
for these patients. The purpose of this study was to determine whether chronic pain
in postmastectomy patients can be diagnosed reliably in an office setting and
pain reduced by intercostal sensory neurectomy. The authors performed a
retrospective review of seven patients with a history of breast surgery and
chronic pain who underwent intercostal neurectomy combined with muscle or
dermal wrapping of the proximal end of the resected nerve. All patients were
diagnosed by history and physical examination, and suspected nerves were
further identified with local anesthetic nerve blocks. An average of 3.14
neurectomies were performed per patient (range, one to six). There was a
significant reduction in visual analogue scale pain scores following surgery,
from 9 preoperatively to 1 postoperatively (p = 0.02). Eighty-six percent of
patients were pain-free or “considerably improved” at their latest follow-up
appointment (average, 6.14 months). It is concluded that intercostal sensory
nerve injury at the time of mastectomy and/or reconstruction can lead to
chronic mastectomy pain, which can be easily diagnosed and effectively treated
with intercostal neurectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic,
IV.
