Breast Reconstruction Does Not Increase the Incidence of Postmastectomy Pain Syndrome: Results of a Meta-Analysis.

Abstract

Postmastectomy pain syndrome (PMPS) is characterized by neuropathic pain from direct nerve injury during oncologic breast surgery causing chronic pain, often leading to chronic opioid dependence and long-term disability. To our knowledge, this study represents the first meta-analysis that defines the incidence of PMPS in patients undergoing mastectomy, with and without breast reconstruction. The Cochrane, Embase, MEDLINE, and PubMed databases were queried. A total of 166 citations from 1991 to 2017 were reviewed to identify 22 unique manuscripts. Inclusion criteria required: (i) minimum 3-month follow-up, (ii) pain in breast, (iii) pain after mastectomy, (iv) documentation of any reconstruction, and (v) minimum of level three evidence. Comprehensive Meta- Analysis Software and Microsoft Excel were used for statistical calculations. Sixteen manuscripts described the prevalence of postmastectomy pain and 11 described the prevalence of postreconstruction pain (5 had data for both). Study population size ranged from 32 to 1165 patients. All studies were classified as level 2 or level 3 evidence. The mean prevalence of pain after mastectomy alone using a random-effects model is 35.6% (30.3%-41.3%). Mean prevalence of pain after mastectomy with reconstruction using the random-effects model is 32.8% (24.4% - 42.5%). Analysis of variance analysis showed no significant difference between prevalence of chronic pain after mastectomy alone versus mastectomy and reconstruction (P = 0.88). Our meta-analysis establishes that postmastectomy reconstruction does not increase the incidence of PMPS. However, because this neuropathic pain often persists after reconstructive surgery, it is incumbent on the plastic surgeon to counsel patients on PMPS. Moving forward, prospective studies on the effects of reconstruction type and adjunct procedures are warranted.