Lack of association between breast reconstructive surgery and the development of chronic pain after mastectomy: A propensity matched retrospective cohort analysis

Objectives: To compare if mastectomy with reconstructive surgery had greater incidence of chronic pain compared to mastectomy surgery alone. Materials and methods: The study was a retrospective cohort. Patients who underwent mastectomies with and without reconstruction responded to the modified short form Brief Pain Inventory and the short form McGill pain questionnaire to identify and characterize pain at least 6 months after the surgical procedure. Propensity matching analysis was used to control for covariates differences in the study groups. Results: 310 subjects were included and 132 patients (43%) reported the presence of chronic pain. After propensity score matching to adjust for covariate imbalances, the incidence of chronic pain in the mastectomy group who had additional surgery for breast reconstruction was not different compared to the group who had mastectomy surgery alone, 26 out of 68 (38%) and 27 out of 68 (39%), respectively P=1.0. Among patients who had chronic pain, breast reconstruction did not increase the intensity of worst pain in the last 24h, median (IQR) of 2 (1-5) compared to 4 (1-5) in the no reconstruction group, P=0.41. Type of reconstruction (breast implants vs. flap tissue) did not result in greater incidence and/or intensity of chronic pain. Conclusions: Breast reconstruction after mastectomy does not result in a greater incidence of chronic pain compared to mastectomy alone. Female patients undergoing breast cancer surgery should not incorporate chronic pain in their decision to undergo reconstructive surgery after mastectomy. Summary: 310 subjects who had mastectomy for breast cancer with or without breast reconstruction were evaluated for the development of chronic pain. After adjusting for confounding covariates, the breast reconstruction did not increase the incidence of chronic pain after mastectomy. Type of reconstruction (breast implant vs. autologous tissue or tissue flaps) also did not interfere with the development of chronic pain. Female patients undergoing breast cancer surgery should not incorporate chronic pain in their decision to undergo reconstructive surgery after mastectomy.