Persistent Postmastectomy Pain: A Comparison of Diagnosis and Patient-reported Outcome Measures in 6988 Patients
Plast Reconstr Surg Glob Open. 2026 Mar 6;14(3):e7517. doi: 10.1097/GOX.0000000000007517. eCollection 2026 Mar.
ABSTRACT
BACKGROUND: The purpose of this study was to assess the utility of the BREAST-Q in identifying patients with persistent postmastectomy pain (PPMP) and to determine predictors of pain among a large reconstructive cohort.
METHODS: We retrospectively reviewed BREAST-Q physical well-being of the chest (PWBC) scores for patients who underwent breast reconstruction from 2010-2023. PPMP was defined by an International Classification of Diseases diagnosis of pain 3 months to 2 years after mastectomy. Linear regression modeled the association between PWBC score and PPMP, and separately modeled associations with demographic and clinical covariates. Multivariable linear mixed-effects regression was used to analyze PWBC scores over time.
RESULTS: A total of 6988 patients (implant N = 5466; autologous N = 1522) had at least 1 PWBC score preoperatively or 1-5 years postoperatively. PPMP (3.2% of patients) was associated with a lower PWBC score (β = -14, P < 0.001). Factors associated with greater odds of PPMP were marital status, number of psychiatric diagnoses, chemotherapy, and radiation. At 1-2 years postoperatively, factors associated with a lower PWBC score included Asian race, Hispanic ethnicity, radiation, and axillary lymph node dissection. Autologous reconstruction demonstrated more favorable long-term PWBC scores compared with implant-based reconstruction.
CONCLUSIONS: PPMP was associated with worse PWBC scores. Radiation was the only common predictor of both PPMP and PWBC scores. This correlation, along with differences in predictors, suggests that the BREAST-Q captures some, but not all, elements of postmastectomy pain. Additional validated measures are needed to measure chronic postoperative pain in the breast cancer population.
PMID:41797858 | PMC:PMC12966117 | DOI:10.1097/GOX.0000000000007517