Unexplained Breast Pain After Mastectomy - You could have Phantom Breast Syndrome
Post-Mastectomy Pain Syndrome (PMPS) and Phantom Breast Syndrome (PBS) that Plague Breast Cancer, especially Mastectomy Patients Post Surgery
If your treatment plan included a mastectomy, were you ever advised by your medical team of the possibility of developing a condition known as Post-Mastectomy Pain Syndrome (PMPS)? I was not, and I experienced something following my double mastectomy that I was totally unprepared for, I developed debilitating shoulder pain which evolved into a condition known as “frozen shoulder”. This condition didn’t occur immediately after my surgery but months later. By this time, I had achieved full range of arm motion so this new pain, which was quite severe, was totally unexpected. Unfortunately, it a condition that at times still impacts me.
What distressed me was that although I hadn’t been warned of the possibility of PMPS, the development of this condition is indeed quite common. In the words of my physical therapist, “Something breast surgery patients should always be made aware of”, so when it happens, it is recognized and treatment can begin.
The following passage from the American Cancer Society’s Website:
“After having breast cancer surgery, some patients have problems with nerve (neuropathic) pain in the chest wall, armpit, and/or arm that doesn’t go away over time. This is called post-mastectomy pain syndrome (PMPS) because it was first noticed in women who had mastectomies, but it can also happen after other types of breast-conserving surgery (such as a lumpectomy).
The classic symptoms of PMPS are pain and tingling in the chest wall, armpit, and/or arm. Pain may also be felt in the shoulder or surgical scar area. Other common complaints include: numbness, shooting or pricking pain, or unbearable itching. Most women with PMPS say their symptoms are not severe but still cause anxiety.
Statistics note that between 20% and 30% of women develop symptoms of PMPS after surgery. It's most common after operations that remove tissue in the upper outside portion of the breast or the underarm area. PMPS is thought to be linked to damage done to the nerves in the armpit and chest during surgery. But the causes are not known for sure.”
So why…if the statistics show that 20-30% of breast surgeries result in this condition, why are patients not advised of the possibility? Not only can it occur following, mastectomy but to any breast and chest surgery including when expanders are exchanged for implants.
When my frozen shoulder happened, I thought I had pulled a muscle. At first, I could manage the pain with Tylenol, but it progressively degraded to the point when I could not move my arm without a shooting pain. To manage the situation, I tried not to use that arm and the net result was a frozen shoulder. I should have called my oncologist when the pain first occurred, but I had no idea at the time that it was related to my breast cancer surgery. As I said, I merely thought I had pulled a muscle.
After discussing this with my oncologist, I received a prescription for six weeks of physical therapy twice a week. The therapy included massage therapy, and more, but different, range of motion exercises. Since this was a nerve condition and not a muscle pull, the therapy that seemed to help the most was TENS therapy.
Transcutaneous electrical nerve stimulation referred to as TENS is a therapy that uses low voltage electrical current to provide pain relief. A TENS unit consists of a battery-powered device that delivers electrical impulses through electrodes placed on the surface of your skin. This therapy would be used at the end of each therapy session and was followed by an ice pack applied to the area for 20 minutes.
Although my situation gradually improved and the pain subsided, that shoulder is still weaker than the other and occasionally pain returns. It is interesting that it occurred in my left shoulder, and the left breast contained the most invasive cancer. Since the exact cause of the condition is not certain, I can’t be sure if this is at all relevant. Compared to cancer, this condition seems not to be of great concern to the medical community since there appears to be little interest in further research.
Another similar condition which actually occurs in the breast is a condition known as “Phantom Breast Syndrome” or (PBS). PBS is a condition in which patients have a sensation of residual breast tissue and can include both non-painful sensations as well as phantom breast pain. Patients with PBS may experience pain, discomfort, itching, pins and needles sensations, tingling, pressure, burning, or throbbing. The syndrome can start anytime following surgery, even years later. Incidence statistics vary across different studies, ranging from approximately 30% to as high as 80% of patients after mastectomy. It seriously affects quality of life due to the impact of the physical disability and emotional stress.
The prevalence of phantom breast syndrome (the sensation that a breast is still present after it is removed) varies in different studies, but is thought to occur in 10% to 55% of women following a mastectomy. Phantom breast pain and sensations usually begin within the first year following a mastectomy and often become less noticeable two years after surgery.
Symptoms that can be experienced with phantom breast syndrome are similar to those experienced after amputation of an arm or a leg (but usually less painful). These may include:
Itching (though scratching doesn't help and this can be distressing)
Pins and needles sensation
Pressure or heaviness
Electric shock type sensations
Premenstrual breast discomfort type of symptoms
The sensations may be felt all over the breast, just