Persistent Postmastectomy Pain: A Comparison of Diagnosis and Patient-reported Outcome Measures in 6988 Patients

The purpose of this study was to assess the utility of the BREAST-Q in identifying patients with persistent postmastectomy pain (PPMP) and to determine predictors of pain among a large reconstructive cohort.

We retrospectively reviewed BREAST-Q physical well-being of the chest (PWBC) scores for patients who underwent breast reconstruction from 2010-2023. PPMP was defined by an International Classification of Diseases diagnosis of pain 3 months to 2 years after mastectomy. Linear regression modeled the association between PWBC score and PPMP, and separately modeled associations with demographic and clinical covariates. Multivariable linear mixed-effects regression was used to analyze PWBC scores over time.

A total of 6988 patients (implant N = 5466; autologous N = 1522) had at least 1 PWBC score preoperatively or 1-5 years postoperatively. PPMP (3.2% of patients) was associated with a lower PWBC score (β = -14, P < 0.001). Factors associated with greater odds of PPMP were marital status, number of psychiatric diagnoses, chemotherapy, and radiation. At 1-2 years postoperatively, factors associated with a lower PWBC score included Asian race, Hispanic ethnicity, radiation, and axillary lymph node dissection. Autologous reconstruction demonstrated more favorable long-term PWBC scores compared with implant-based reconstruction.

PPMP was associated with worse PWBC scores. Radiation was the only common predictor of both PPMP and PWBC scores. This correlation, along with differences in predictors, suggests that the BREAST-Q captures some, but not all, elements of postmastectomy pain. Additional validated measures are needed to measure chronic postoperative pain in the breast cancer population.