Oct. 20, 2000 SAN FRANCISCO -- Some women experience "phantom" pain and other sensations after a mastectomy as if the breast had never been removed. Similar to feelings experienced by some leg or arm amputees, these sensations can persist for months.
Research reported at the annual meeting of the American Society of Anesthesiologists indicates that phantom breast pain (PBP) and phantom breast sensations (PBS) occur in about a third of mastectomy patients. The study also found that having breast reconstruction surgery after mastectomy does not reduce the likelihood that these sensations will occur.
"Women who choose to have breast reconstruction surgery after mastectomy are just as likely to experience phantom breast sensations (PBS) and pain (PBP) as women who opt not to undergo breast reconstruction," Srinivasa Raja, M.D., an anesthesiologist at Johns Hopkins University, said.
Researchers sent a questionnaire to 504 women who had mastectomies at the hospital between 1996 and 1999. Of the 279 who responded, 48 percent had chosen cosmetic surgery and 52 percent had chosen mastectomy alone. Of the respondents, 39 percent reported PBS and 31 percent reported PBP.
"The major predictor of PBS and PBP after mastectomy was the presence of breast pain prior to mastectomy. Breast pain before surgery doubled the incidence of postsurgical PBP and PBS," Dr. Raja said.
Patients with and without breast reconstruction reported similar levels of PBS and PBP. Common PBS included itching, throbbing, "pins and needles" sensations and feelings of pressure.
The similar PBS and PBP rates among the two groups surprised the researchers, Dr. Raja said. "We thought having a replacement breast would lower the incidence of phantom pain and sensations," he said.
In addition, women aged 60 years and older reported significantly less pain than women under the age of 60 (53 percent versus 66 percent, respectively).
The women who reported more pain also reported greater fears about the possible recurrence of cancer and greater concerns that the surgery had a negative impact on their sex lives.
About half of the women surveyed reported pain after mastectomy in other regions of the body such as the arm and chest wall. Again, choice of surgery did not influence the likelihood of experiencing pain in these regions, the researchers reported.
The study also explored the impact of the two types of surgery on women's ability to function. Although the women in the breast reconstruction group reported significantly more muscle weakness and numbness than those in the mastectomy alone group (82 percent versus 65 percent), the two groups did not differ in their ability to function despite this discomfort.
The incidence of depression was about the same in the two groups as well, but depression was more common among women from either group who had also experienced pain after mastectomy. The finding is understandable because, in general, patients with chronic pain are more likely to be depressed, Dr Raja said.
"We hope this new information will help women with breast cancer make more informed choices regarding their treatment," Dr. Raja said.
Researchers believe phantom pain is the body's way of responding to the trauma of amputation. When nerves are cut, the trauma triggers the development of new nerve tissues called neuromas. These new growths send abnormal signals to the nervous system, which the brain interprets as pain.
Phantom pain also may represent a reorganization of the central nervous system in response to the sudden absence of input from a given area. Normally, neurons focus on the areas of the body from which they receive signals. When these signals stop coming, neurons in adjacent parts of the body begin sending signals to those neurons as a form of compensation. Breast cancer is the most common type of cancer among women and the second leading cause of death among women.
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