title: Pain after breast surgery: Etiology, diagnosis, and definitive management.
abstract: BACKGROUND
  Breast procedures are among the most common surgeries performed by Plastic Surgeons. The prevalence of persistent pain remains unknown. Our experience has been that persistent breast pain is often related to intercostal nerve trauma. The purpose of this article was to increase awareness of this problem while describing the diagnostic and management strategies for patients with post-operative breast pain.
  
  
  METHODS
  A retrospective review of 10 patients with breast pain was stratified according to the index surgical procedures: implant-based reconstruction (7), breast reduction (1), breast augmentation (1), and mastopexy (1). Outcomes were assessed with a numerical analog score. Physical examination demonstrated painful trigger points along the pathway of one or more intercostal nerves. Prior to surgery, each patient improved ≥5 points after a diagnostic Xylocaine/Marcaine local anesthesia block of the suspected intercostal nerves. At surgery, one or more intercostal nerves were resected and implanted into adjacent muscles.
  
  
  RESULTS
  At a mean of 16.5 months, there were six excellent, one good, and three poor self-reported results. Intercostal nerves resected included the intercostal-brachial (5 patients), 3rd (7 patients), 4th (8 patients), 5th (9 patients), 6th (7 patients), and 7th (1 patient). Multiple intercostal nerves were resected as follows: 3 nerves (4 patients), 4 nerves (1 patient), 5 nerves (3 patients), 6 nerves (1 patient), and 8 nerves (1 patient).
  
  
  CONCLUSIONS
  Intercostal neuromas can be the source of breast pain following breast surgery. The same clinical and diagnostic approach used for upper and lower extremity neuroma pain can be used in patients with breast pain. © 2016 Wiley Periodicals, Inc. Microsurgery 36:535-538, 2016.
authors.affiliation: Deparment of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD. justin.broyles@gmail.com.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Broyles
authors.affiliation: Deparment of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Sami H
authors.initials: SH
authors.lastname: Tuffaha
authors.affiliation: Deparment of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.|The Dellon Institute for Peripheral Nerve Surgery, Towson, MD.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Williams
authors.affiliation: Long Island Plastic Surgical Group, Garden City, NY.
authors.forename: Laurence
authors.initials: L
authors.lastname: Glickman
authors.affiliation: The Dellon Institute for Peripheral Nerve Surgery, Towson, MD.
authors.forename: Taylor A
authors.initials: TA
authors.lastname: George
authors.affiliation: Deparment of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.|The Dellon Institute for Peripheral Nerve Surgery, Towson, MD.
authors.forename: A
authors.initials: A
authors.lastname: Lee Dellon
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007367:Intercostal Nerves / Q000293:injuries* / Q000601:surgery; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D016067:Nerve Transfer; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D059348:Peripheral Nerve Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D010808:Physical Examination; D012189:Retrospective Studies; D016896:Treatment Outcome