Breast reconstruction with an expander prosthesis following mastectomy does not cause additional persistent pain: A nationwide cross-sectional study

Klit, Anders; Mejdahl, Mathias Kvist; Gärtner, Rune; Elberg, Jens Jørgen; Kroman, Niels; Andersen, Kenneth Geving

doi:10.1016/j.bjps.2013.07.015

Cited by 24 publications

(18 citation statements)

References 18 publications

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“…Univariate analysis suggested more pain among patients with reconstruction of the breast, with a tendency toward higher pain scores (p ¼ 0.06). However, the adjusted model rejected this with no difference between the treatment groups, which is supported by research in IBC patients [21]. The finding of an association between psychological factors and persistent pain is supported by similar findings in IBC patients [3].…”

Section: Discussionsupporting

confidence: 58%

Pain, sensory disturbances and psychological distress are common sequelae after treatment of ductal carcinoma in situ: a cross-sectional study

et al. 2017

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Section: Discussionsupporting

confidence: 58%

Pain, sensory disturbances and psychological distress are common sequelae after treatment of ductal carcinoma in situ: a cross-sectional study

et al. 2017

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“…9 and others 10 that breast reconstruction adds increased pain burden for women undergoing mastectomy, as the women in these studies with reconstruction reported more persistent pain than women receiving mastectomy alone. However, recently two retrospective cohort studies 12,41 compared women who had undergone mastectomy alone or with immediate breast reconstruction, at least 6 months or longer from their surgery, for the presence of persistent pain. For both studies a range between 40–48% of the respective study samples reported some level of chronic pain.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with acute postoperative pain following breast reconstruction

et al. 2017

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Summary Introduction Post-mastectomy breast reconstruction has become an increasingly important component of breast cancer treatment. Unfortunately, some patients experience severe postoperative pain, placing them at risk for increased clinical morbidity and the development of disabling chronic pain. In an attempt to identify at-risk patients, we prospectively evaluated patient characteristics and medical/surgical variables associated with more severe acute post-reconstruction pain. Methods Women (N = 2207; one-week 82.8% response rate) undergoing breast reconstruction were assessed for pain experience, anxiety, depression, and sociodemographic characteristics prior to surgery. Pain assessments were made preoperatively and postoperative at 1-week using validated survey instruments including the McGill Pain Questionnaire-Short Form (MPQ-SF), Numerical Pain Rating Scale (NPRS), and BREAST-Q Chest and Upper Body scale. Depressive symptoms and anxiety severity were assessed by the Patient Health Questionnaire and Generalized Anxiety Disorders Scale, respectively. Mixed-effects regression modeling was used to examine the relationships between patient characteristics and medical/surgical factors and 1-week postoperative pain. Results Younger age, bilateral reconstruction, and severity of preoperative pain, anxiety and depression were all associated with more severe acute postoperative pain on all the pain measures and BREAST-Q. Comparison of surgical procedure type indicated less severe postoperative pain for PTRAM, DIEP and SIEA reconstructive surgery compared to tissue expander/implant reconstruction. Conclusions This study identified patients at risk for greater acute postoperative pain following breast reconstruction. These findings will allow plastic surgeons to better tailor postoperative care to improve patient comfort, reduce clinical morbidity, and further enhance patient satisfaction with their surgical outcome.

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“…Further head-to-head comparison revealed that in 7 of the 12 studies that incorporated both risk factors into multivariable regression models, neither were significant, and radiation was found to be the one to be independently associated with PPSP in 4 studies. 16,23,30,42 Ideally, isolating the effect of each perioperative treatment modality would provide more objective results for clinicians to consider in their risk-benefit analysis. Another limitation is that many studies did not specify the type and dosage of chemotherapy or radiotherapy, which could be potentially important factors affecting the variability in pain outcomes.…”

Section: Perioperative Cancer Management and Anesthesiamentioning

confidence: 99%

Risk factors for persistent pain after breast and thoracic surgeries: a systematic literature review and meta-analysis

Lim

Chen

McNicol

et al. 2021

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Persistent postsurgical pain (PPSP) is common after breast and thoracic surgeries. Understanding which risk factors consistently contribute to PPSP will allow clinicians to apply preventive strategies, as they emerge, to high-risk patients. The objective of this work was to systematically review and meta-analyze the literature on risk factors of PPSP after breast and thoracic surgeries. A systematic literature search using Ovid Medline, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, and Scopus databases was conducted. Study screening with inclusion and exclusion criteria, data extraction, and risk of bias assessment was performed independently by 2 authors. The data for each surgical group were analyzed separately and meta-analyzed where possible. The literature search yielded 5584 articles, and data from 126 breast surgery and 143 thoracic surgery articles were considered for meta-analysis. In breast surgery, younger age, higher body mass index, anxiety, depression, diabetes, smoking, preoperative pain, moderate to severe acute postoperative pain, reoperation, radiotherapy, and axillary lymph node dissection were the main factors associated with higher risk of PPSP. In thoracic surgery, younger age, female sex, hypertension, preoperative pain, moderate to severe acute postoperative pain, surgical approach, major procedure, and wound complications were associated with PPSP. This systematic review demonstrated certain consistent risk factors of PPSP after breast and thoracic surgeries, as well as identified research gaps. Understanding the factors that increase susceptibility to PPSP can help selectively allocate resources to optimize perioperative care in high-risk patients and help develop targeted, risk-stratified interventions for PPSP prevention.

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Breast reconstruction with an expander prosthesis following mastectomy does not cause additional persistent pain: A nationwide cross-sectional study

Cited by 24 publications

References 18 publications

Pain, sensory disturbances and psychological distress are common sequelae after treatment of ductal carcinoma in situ: a cross-sectional study

Pain, sensory disturbances and psychological distress are common sequelae after treatment of ductal carcinoma in situ: a cross-sectional study

Factors associated with acute postoperative pain following breast reconstruction

Risk factors for persistent pain after breast and thoracic surgeries: a systematic literature review and meta-analysis

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