Epidemiology and Predictive Factors for Persistent Breast Pain Following Breast-Conserving Surgery

Abstract

Background In general, breast pain is one of the most common causes for referral to breast units; treatment-related breast pain is frequently seen in clinical practice but not well addressed in the literature. While our primary objective was to identify the incidence of persistent breast pain following breast-conserving surgery and possible risk factors, our secondary aim was to assess the possibility of using a breast ultrasound scan to detect parenchymal changes that can contribute to breast pain. Methods We have conducted a prospective study including patients who had wide local excision for primary breast cancer treatment between January 2017 and January 2019. Patients' demographics, including age, BMI, breast volume, and tumour characteristics, were noted. All patients had a clinical assessment and were asked standard questions about their breast pain each visit; they also had an ultrasound scan of the breast and axilla 6 and 12 months after surgery to look for parenchymal changes. Results A total of 239 female breast cancer patients were included in our analysis. The mean age was 43.9 years, mean weight was 72.8 kg, mean BMI was 27.4 and mean breast volume was 1173 ml. In total, 38.5% had standard wide local excision, and 61.5% had oncoplastic resection; the mean specimen weight was 74.6 grams. All patients had adjuvant whole breast radiotherapy. We found that patients with younger age, larger breast size, high BMI, oncoplastic resections, and persistent parenchymal changes are associated with an increased incidence of postoperative breast pain while the type of axillary procedure and adjuvant chemotherapy had no significant effect. Conclusion Persistent postoperative breast pain was noted in 33% of our patients. We have also indicated that younger patients, patients with larger breast, those with high BMI, with preoperative breast pain, who had oncoplastic resections, and patients with persistent parenchymal changes, as fat necrosis and scarring, are associated more with persistent breast pain.

Keywords: breast cancer; breast pain; fat necrosis; scaring; ultrasound scan.