title: Complex regional pain syndrome of the breast in a patient after breast reduction.
abstract: Complex regional pain syndrome (CRPS) is characterized by devastating pain, swelling, and cutaneous discoloration that result from vasomotor dysfunction caused by an abnormally accelerating sympathetic loop reflex after trauma or surgery. Although in the extremities CRPS is well documented as reflex sympathetic dystrophy, it only has been reported anecdotally in the breast after modified radical mastectomy and never reported after breast reduction. We report CRPS in the right breast of a 27-year-old woman after revision breast reduction surgery. The patient had signs of CRPS and symptoms of pain, swelling, epidermal scaling, and cutaneous temperature changes lasting more than 1 year. Liquid crystal thermographic scanning revealed a persistent, clinically significant hypothermic region in the affected breast. Intravenous phentolamine temporarily relieved the symptoms. Subsequent sympathetic blockade of the stellate ganglion alleviated chronic CRPS symptoms. Surgeons should be alert that CRPS may need to be considered in the differential diagnosis of chronic disproportionate pain after breast surgery. Early identification and treatment will help alleviate persistent CRPS symptoms and avoid soft-tissue changes.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, OH 44195, USA.
authors.forename: F A
authors.initials: FA
authors.lastname: Papay
authors.forename: A
authors.initials: A
authors.lastname: Verghese
authors.forename: M
authors.initials: M
authors.lastname: Stanton-Hicks
authors.forename: J
authors.initials: J
authors.lastname: Zins
mesh_terms: D000328:Adult; D000779:Anesthetics, Local; D001340:Autonomic Nerve Block; D001940:Breast / Q000294:innervation; D002045:Bupivacaine; D005260:Female; D006801:Humans; D016462:Mammaplasty; D010149:Postoperative Pain / Q000209:etiology* / Q000628:therapy; D012019:Reflex Sympathetic Dystrophy / Q000209:etiology* / Q000628:therapy; D012086:Reoperation; D012881:Skin Temperature / Q000187:drug effects / Q000502:physiology; D013233:Stellate Ganglion / Q000187:drug effects; D013817:Thermography
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine