Phantom breast syndrome: The effect of in situ breast carcinoma

Phantom breast syndrome (PBS) represents the experience of the continued presence of the breast, after mastectomy. Our aim was to assess PBS appearance by means of a structured questionnaire and to look into possible associations to disease and treatment parameters, in 105 women with breast cancer treated by mastectomy. PBS was recorded in 22.9% of the patients. In the majority of cases phantom experience had the size (88.9%), shape (76.5%) and weight (64.7%) of the normal breast and was localised in the entire breast (50%). Concerning disease parameters, no association with primary tumour size (T) or lymph node status was detected, but interestingly, in situ breast cancer (DCIS) was found to be more frequently associated with PBS, compared with invasive tumours. No significant associations of PBS with previous sensory experiences of the breast, radiotherapy or systemic treatment were assessed. The results are interpreted within the frame of Melzack's theory of a neuromatrix, assuming that PBS represents the continued existence, even after amputation, of a sensory engram of the breast. The absence of infiltration in primary tumour histology, probably through an unknown pathophysiological mechanism, might play a role for the significantly higher incidence of PBS in women undergoing mastectomy for DCIS.