Post-mastectomy pain syndrome after mamma reduction plasty, an unusual case report

CRPS (complex regional pain syndrome) is well documented as a reflex sympathetic dystrophy. It mostly has been reported to occur in the extremities and has only been mentioned anecdotally in the breast after breast surgery or trauma of the chest wall. Recent literature describes a post-mastectomy pain syndrome (PMPS), which mimics CRPS symptoms and, despite the nomenclature, is not only limited to mastectomy procedures but also any other surgical procedure involving breast parenchyma. We report PMPS in a 39-year-old patient after revision operation of breast reduction surgery. Postoperatively, the patient showed symptoms of severe persistent pain, swelling, cutaneous temperature changes, and hyperhidrosis in the affected breast. Subcutaneous infiltration with triamcinolone acetonide and prilocaine only relieved the symptoms temporarily. Botox injections did not relieve her symptoms of sweating either. Two intercostal nerve branches were identified with ultrasonography and dissected in general anesthesia. This procedure relieved her symptoms. Surgeons should consider CRPS and PMPS as differential diagnosis of chronic disproportionate pain after breast surgery. Early identification and treatment will help alleviate persistent CRPS symptoms and avoid chronic soft tissue changes. Level of evidence: Level IV, diagnostic/therapeutic study.