Persistent pain following postmastectomy breast reconstruction: long-term effects of type and timing of surgery.

This study prospectively examined the long-term effects of type (transverse rectus abdominis musculocutaneous [TRAM] versus implant) and timing (immediate versus delayed) of postmastectomy reconstructive surgery on patient reports of pain at multiple body sites. Women (n = 205) seeking immediate or delayed breast reconstruction, choosing either expander implant or autologous tissue transfer surgical procedures, provided ratings for the presence of bodily, breast, abdominal, and back pain and abdominal tightness prior to surgery and at 2-year follow-up. At baseline, nonwhite women were more likely to undergo delayed reconstruction (P < 0.05), and women seeking delayed reconstruction had less breast pain (P < 0.001) and more back pain (P < 0.01). Multiple regression analyses, controlling for ethnicity and baseline pain, indicated that women receiving TRAM flap surgery reported more problems with abdominal pain and tightness. There was a trend for implant subjects to report more frequent problems with breast pain. These results suggest the need for heightened awareness of potential long-term pain morbidity for women undergoing TRAM flap or implant breast reconstruction.