From the Guidelines
Neuropathy after mastectomy is primarily caused by nerve damage during surgery, with the intercostobrachial nerve being the most commonly affected, resulting in numbness, tingling, or pain in the upper inner arm and axilla. The most common causes of neuropathy post mastectomy include:
- Injury to the intercostobrachial nerve, which supplies sensation to the upper inner arm and axilla, resulting in numbness, tingling, or pain in these areas 1
- Surgical techniques like axillary lymph node dissection, which significantly increase the risk of nerve damage
- Post-surgical inflammation, scar tissue formation that compresses nerves, or radiation therapy causing delayed nerve damage Other nerves that may be damaged include the long thoracic nerve (causing winged scapula) and thoracodorsal nerve (affecting latissimus dorsi function) 1. Risk factors for neuropathy post mastectomy include:
- More extensive surgery
- Radiation therapy
- Chemotherapy (especially taxanes like paclitaxel)
- Pre-existing conditions like diabetes Management of neuropathy post mastectomy typically involves multimodal pain control with medications like duloxetine (30-60mg daily), which has been shown to decrease neuropathic pain significantly more than placebo, and may also improve numbness and tingling 1, along with physical therapy to maintain range of motion and prevent further complications. Early identification and treatment of neuropathic symptoms can significantly improve quality of life after mastectomy. Additionally, physical activity has been shown to improve arthralgias, neuropathy, and neuropathy symptoms in breast cancer survivors 1. It is essential to assess for peripheral neuropathy and contributing factors by asking the patient about their symptoms, specifically numbness and tingling in their hands and/or feet, and the characteristics of that symptom 1.
From the Research
Neuropathy Post Mastectomy Causes
- Neuropathy post mastectomy, also known as postmastectomy pain syndrome (PMPS), is a common and debilitating form of postsurgical pain with neuropathic characteristics, presenting as burning, stabbing, or pulling sensations after mastectomy, lumpectomy, or other breast procedures 2.
- The underlying pathophysiology of PMPS is likely multifactorial, although exact mechanisms have yet to be elucidated, with neuralgia of the intercostobrachial nerve currently implicated as the most common cause of PMPS 3.
- Risk factors for PMPS include younger age, psychosocial factors, radiotherapy, axillary lymph node dissection, and a history of chronic pain 2.
- Chemotherapy, such as paclitaxel, can also induce peripheral neuropathy, which may impact the quality of life and treatment outcomes 4.
- Nerve injury during axillary surgery is another potential cause of neuropathy post mastectomy 5.
Related Conditions
- Postmastectomy pain syndrome (PMPS) is characterized by persistent pain affecting the anterior thorax, axilla, and/or medial upper arm following mastectomy or lumpectomy 3.
- Chemotherapy-induced neuropathy is a dose-limiting side effect of taxanes, which can cause neuropathic pain and impact treatment outcomes 4, 6.
- Reduced tactile sensation after mastectomy is another potential complication of breast surgery 5.
Treatment Options
- Pharmacological treatment options for PMPS include antidepressants, gabapentinoids, levetiracetam, capsaicin, and topical lidocaine 2.
- Procedural and surgical options for PMPS include fat grafting, nerve blocks, radiofrequency ablation, peripheral nerve surgery, serratus plane block, and botulinum toxin injections 2.
- Gabapentin has been shown to be effective in preventing intermediate and high-grade neuropathies induced by paclitaxel chemotherapy 4.
- Pregabalin may be considered as a potential treatment option for chemotherapy-induced neuropathy, although further study is needed 6.