Chronic postoperative pain and sensory changes following reduction mammaplasty

Background Few studies have examined persistent pain after reduction mammaplasty, and sensory changes remain a controversial subject with studies reporting both reduced, improved, and unchanged skin sensitivity following surgery. The aim of the present study was to describe the prevalence, character, and impact of sensory changes and persistent pain following breast reduction surgery and to assess possible causes and predictors of persistent sensory changes and chronic pain. Methods In May 2010, a detailed questionnaire was mailed to all 109 patients who underwent reduction mammaplasty at the Department of Plastic Surgery, Aalborg Hospital from September 2004 to February 2010. Ninety patients (83%) returned the questionnaire; mean age was 48.7 years (SD 14.7); and mean time since surgery was 27.7 months. Results Eight patients reported that they had sensory abnormalities in the breasts before surgery, which normalized or improved in four, remained unchanged in one, and worsened in three patients following surgery. Forty-nine patients (54%) reported sensory changes in the nipple-areola complex or skin as a consequence of surgery. Sixty-nine patients reported having pain before surgery (most often in the neck/back), which was completely relieved in 42% and partially in 43%. Twenty-five patients (28%) reported having pain in the breasts as a consequence of the operation: 20% had chronic pain (defined as constant pain or pain at least once weekly for at least 3 months) and 7% had moderate to severe pain. In more than half of the patients, the pain was compatible with neuropathic pain. Patients with pain tended to be less satisfied with the surgery than those without pain (p = 0.07, Mann-Whitney U test). Young age, time since surgery, complications to surgery and sensory abnormalities before surgery were significantly related to pain. Conclusion Reduction mammaplasty relieved neck and back pain in most patients, but the surgery is associated with a risk of developing new sensory abnormalities and persistent neuropatic pain. Implications The clinical implication of this study is that reduction mammaplasty may sooth preexisting neck- and back pain, but may lead to a new condition in the patient with chronic sensory changes and pain in the breasts.