Nerve injuries following reconstructive and cosmetic breast surgery: A systematic review and meta-analysis

Breast surgery carries the risk of intercostal nerve injuries, with symptoms ranging from sensory disturbances to chronic pain. This study characterizes post-operative intercostal nerve injuries following breast surgery and available microsurgical management options.

A systematic review was conducted using PubMed, Embase, Web of Science, and Scopus for the years 2003-2024. The primary inclusion criteria was a patient experiencing any neuropathic symptoms (defined as pain or sensory changes) following mastectomy, breast reconstruction, or aesthetic breast surgery.

Of 514 unique studies, 39 (n = 9083 patients) were included. The procedures included breast augmentation (n = 6291, 69.3 %), mastectomy without reconstruction (n = 1701, 18.7 %), mastectomy with reconstruction (n = 654, 7.2 %), and breast reduction (n = 434, 4.9 %). After these procedures, 1144 (12.6 %) patients experienced chronic pain and 135 (1.8 %) had nerve injuries, consisting of intercostal nerves (n = 133, 98.5 %) or brachial plexus nerves (n = 2, 1.5 %). Of patients with nerve injuries, 23 (9.2 %) underwent surgical interventions, which included neurectomy (n = 11, 47.8 %), neuroma excision (n = 10, 43.5 %), implant removal (n = 8, 34.8 %), and dorsal rhizotomy (n = 1, 4.3 %).

This study demonstrates a substantial risk of chronic pain and peripheral nerve injuries following breast surgery. The low utilization of surgical options (4.6 %) may indicate limited patient unawareness of the pain relief which microsurgical intervention offers when conservative approaches fail in reduction or resolution of symptoms.