From the Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine.
Departments of Endocrinological and Breast Surgery.
Ann Plast Surg. 2022 May 1;88(5):490-495. doi: 10.1097/SAP.0000000000003146.
After breast surgery with or without immediate reconstruction, chronic pain can be a major problem for patients. However, few studies have examined the details of the sites of long-lasting postoperative pain. In this study, we specified the postoperative pain location after breast surgery, including reconstruction, to find ways to improve surgical procedures or provide effective pain relief.
The subjects were 205 Japanese women undergoing mastectomy or breast reconstruction with a tissue expander (TE)/implant or a deep inferior epigastric perforator (DIEP) flap. Patients were asked whether they had pain in different parts of the body at 1 year after surgery. Differences were assessed by cross-tabulation and χ2 statistics.
Surveys were completed by 157 subjects. Deep inferior epigastric perforator flap cases had significantly more pain and TE/Imp cases had significantly less pain in the medial breast, upper breast, breast upper medial quadrant, and abdomen (P = 0.006, P = 0.006, P < 0.001, P < 0.001, respectively). In the neck area, pain in TE/Imp cases was significantly worse than that in all other patients (P = 0.025). There was no significant difference in chronic pain in any other body regions among the mastectomy only, TE/Imp, and DIEP flap groups.
The results of the present study revealed that the localization of prolonged postoperative pain after breast surgery differs depending on the surgical procedure. In DIEP flap reconstruction, there was a marked tendency for pain in the inner and upper chest and in the abdomen, whereas TE/IMP surgery resulted in pain around the neck of the affected side. These findings may help improve surgical methods and establish effective pain relief that focuses on the identified pain areas.
乳房手术后（无论是否立即进行重建），慢性疼痛可能是患者的主要问题。然而，很少有研究探讨长期术后疼痛的部位细节。在这项研究中，我们明确了乳房手术后，包括重建后的术后疼痛部位，以寻找改善手术程序或提供有效止痛的方法。
研究对象为 205 名接受乳房切除术或组织扩张器（TE）/植入物或腹壁下动脉穿支（DIEP）皮瓣重建的日本女性。术后 1 年，患者被询问身体不同部位是否有疼痛。采用交叉表和卡方检验评估差异。
157 名患者完成了调查。DIEP 皮瓣组的患者在乳房内侧、乳房上部、乳房上内侧象限和腹部的疼痛明显更多，而 TE/Imp 组的疼痛明显更少（P = 0.006，P = 0.006，P < 0.001，P < 0.001）。在颈部区域，TE/Imp 组的疼痛明显比其他所有患者更严重（P = 0.025）。在任何其他身体区域，单纯乳房切除术、TE/Imp 和 DIEP 皮瓣组之间的慢性疼痛无显著差异。
本研究结果表明，乳房手术后延长性术后疼痛的定位因手术方式而异。在 DIEP 皮瓣重建中，胸部内侧和上部以及腹部有明显的疼痛倾向，而 TE/IMP 手术则导致患侧颈部周围疼痛。这些发现可能有助于改善手术方法并建立针对特定疼痛区域的有效止痛方法。
