title: Chronic postoperative breast pain: danger zones for nerve injuries.
abstract: BACKGROUND
  Postoperative breast pain is a frequent complaint, reported by 50 percent of women following a breast procedure. Breast pain interferes with sexual activity, as reported by 48 percent of patients, exercise (36 percent), social activity (13 percent), and employment (6 percent).
  
  
  METHODS
  To define neurogenic causes of chronic postoperative breast pain, the authors performed a retrospective review of consecutive patients from a single surgeon and performed 10 anatomical bilateral dissections. The authors evaluated the most commonly injured nerves, based on zone of injury, injury type, and precedent breast procedure. Dissections referenced the zone of injury with the specific procedure and designated the individual nerves at risk.
  
  
  RESULTS
  The authors identified 57 patients with chronic breast pain from breast reconstruction (n = 38), reduction (n = 2), mastopexy (n = 2), augmentation (n = 4) and irradiation (n = 11). On the basis of anatomic innervation, the authors designated five zones of nerve injury: superior, medial, inferior, lateral, and central/nipple-areola complex. The lateral zone was most commonly injured (79 percent), followed by inferior (10.5 percent), medial (5 percent), central (3.5 percent), and superior (2 percent) zones. Forty-two patients suffered intercostal nerve neuromas from mechanical nerve trauma/entrapment, with pain at the surgical scar or nearby tissue dissection. Four patients with traction-stretch neuropathy had pain from blunt augmentation pocket dissection. Eleven patients with irradiation-induced neuropathy had diffuse, nonlocalized nerve pain.
  
  
  CONCLUSIONS
  By shifting the approach to chronic breast pain from "global chronic breast pain" to defined danger zones of nerve injury, the practitioner can identify the type of nerve injury and associate the most common nerve injury to a given breast procedure. This approach should assist in diagnosis and treatment, and ultimately improve patient morbidity.
authors.affiliation: Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital.
authors.forename: Ivica
authors.initials: I
authors.lastname: Ducic
authors.forename: Laura A
authors.initials: LA
authors.lastname: Seiboth
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Iorio
mesh_terms: D001940:Breast / Q000294:innervation* / Q000528:radiation effects; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007367:Intercostal Nerves / Q000293:injuries; D016462:Mammaplasty / Q000009:adverse effects; D009463:Neuroma / Q000209:etiology; D010149:Postoperative Pain / Q000175:diagnosis*; D059348:Peripheral Nerve Injuries; D010524:Peripheral Nervous System Neoplasms / Q000209:etiology; D012189:Retrospective Studies