Wallace M S, Wallace A M, Lee J, Dobke M K
Department of Anesthesiology, University of California at San Diego, USA.
Pain. 1996 Aug;66(2-3):195-205. doi: 10.1016/0304-3959(96)03064-3.
Breast surgery is a common procedure performed in women. Many women who undergo breast surgery suffer from ill-defined pain syndromes. Although there exists a few reports on the incidence of post mastectomy pain, there are no published reports on chronic pain after breast reconstruction. This investigation attempts to characterize the pain after four types of breast surgery: (1) mastectomy, (2) mastectomy with reconstruction, (3) cosmetic augmentation, and (4) breast reduction. A questionnaire was mailed to 479 women who underwent breast surgery at the University of California, San Diego Medical Center between January 1988 and December 1992. A second mailing was sent to women who did not respond to the first mailing. Women were divided into four groups; mastectomy, mastectomy with reconstruction, cosmetic augmentation, and breast reduction. In the mastectomy and mastectomy with reconstruction groups, only women who had a lumpectomy with axillary dissection, a modified radical mastectomy, or a radical mastectomy were used in the study. 59% of the women responded. The incidence of pain occurring at least one year after surgery in the mastectomy + reconstruction group (49%) was significantly higher than the mastectomy (31%) and breast reduction (22%) groups. Thirty-eight percent of the women with breast augmentation complained of pain. Women who had reconstruction using breast implants had a higher incidence of pain (53%) than those without (30%). The pain incidence in women who had reconstruction without implants was identical to women who had a mastectomy without reconstruction. There was no relationship between the use of silicone or saline implants and pain (22% and 33% respectively). However, the submuscular placement of the implants resulted in a significantly higher incidence of pain (50%) than the subglandular placement (21%). Of the women that reported pain, arm pain was significantly higher in the mastectomy and mastectomy + reconstruction group (56% and 42%, respectively) as compared to the breast reduction group (0%). Most patients reported intermittent pain in all groups. Of the women that reported pain, the mastectomy and mastectomy + reconstruction group had higher pain related to movement (41% and 42%, respectively) than the augmentation and breast reduction groups (15% and 9%, respectively). The peak pain intensity was significantly higher in the augmentation group as compared to the mastectomy group. Our incidence of post mastectomy pain is higher than most reports. The incidence of breast pain is highest in the mastectomy + reconstruction and augmentation groups which is assumed to be secondary to breast implants. Every effort should be made to achieve the best cosmetic result in breast reconstruction which in many cases justifies the use of breast implants. However, these women should be counseled on the possibility of developing chronic pain.
乳房手术是女性中常见的一种手术。许多接受乳房手术的女性患有不明原因的疼痛综合征。虽然有一些关于乳房切除术后疼痛发生率的报告，但关于乳房重建术后慢性疼痛的报告尚未发表。本研究旨在描述四种乳房手术后的疼痛情况：（1）乳房切除术；（2）乳房切除术后重建术；（3）隆胸术；（4）乳房缩小术。向1988年1月至1992年12月在加利福尼亚大学圣地亚哥分校医学中心接受乳房手术的479名女性邮寄了调查问卷。对未回复第一次邮寄的女性进行了第二次邮寄。女性被分为四组：乳房切除术组、乳房切除术后重建术组、隆胸术组和乳房缩小术组。在乳房切除术组和乳房切除术后重建术组中，仅纳入接受过肿块切除加腋窝淋巴结清扫术、改良根治性乳房切除术或根治性乳房切除术的女性进行研究。59%的女性回复了问卷。乳房切除术后重建术组术后至少一年出现疼痛的发生率（49%）显著高于乳房切除术组（31%）和乳房缩小术组（22%）。38%的隆胸女性抱怨疼痛。使用乳房植入物进行重建的女性疼痛发生率（53%）高于未使用植入物的女性（30%）。未使用植入物进行重建的女性疼痛发生率与未进行重建的乳房切除术女性相同。使用硅胶或盐水植入物与疼痛之间没有关联（分别为22%和33%）。然而，植入物置于胸大肌下导致疼痛发生率（50%）显著高于置于乳腺下的情况（21%）。在报告疼痛的女性中，乳房切除术组和乳房切除术后重建术组的手臂疼痛发生率显著高于乳房缩小术组（分别为56%和42%，而乳房缩小术组为0%）。所有组中的大多数患者报告疼痛为间歇性。在报告疼痛的女性中，乳房切除术组和乳房切除术后重建术组与运动相关的疼痛发生率高于隆胸术组和乳房缩小术组（分别为41%和42%，而隆胸术组和乳房缩小术组分别为15%和9%）。隆胸术组的疼痛强度峰值显著高于乳房切除术组。我们的乳房切除术后疼痛发生率高于大多数报告。乳房切除术后重建术组和隆胸术组的乳房疼痛发生率最高，这被认为是乳房植入物所致。在乳房重建中应尽一切努力获得最佳的美容效果，在许多情况下这证明了使用乳房植入物的合理性。然而，应该告知这些女性发生慢性疼痛的可能性。
