RESUMEN
Post-mastectomy pain syndrome (PMPS) is a common and often debilitating condition. The syndrome is defined by chest wall pain unresponsive to standard pain medications and the presence of exquisite point tenderness along the inframammary fold at the site of the T4 and T5 cutaneous intercostal nerve branches as they exit from the chest wall. Pressure at the site triggers and reproduces the patient's spontaneous or motion-evoked pain. The likely pathogenesis is neuroma formation after injury to the T4 and T5 intercostal nerves during breast surgery. We assessed the rate of long-term resolution of post-mastectomy pain after trigger point injections (2 mL of 1:1 mixture of 0.5% bupivacaine and 4 mg/mL dexamethasone) to relieve neuropathic pain in a prospective single-arm cohort study. Fifty-two women (aged 31-92) who underwent partial mastectomy with reduction mammoplasty or mastectomy with or without reconstruction, and who presented with PMPS were enrolled at the University of California San Francisco Breast Care Center from August 2010 through April 2018. The primary outcome was a long-term resolution of pain, defined as significant or complete relief of pain for greater than 3 months. A total of 91 trigger points were treated with mean follow-up 43.9 months with a 91.2% (83/91) success rate. Among those with a long-term resolution of pain, 60 trigger points (72.3%) required a single injection to achieve long-lasting relief. Perineural infiltration with bupivacaine and dexamethasone is a safe, simple, and effective treatment for PMPS presenting as trigger point pain along the inframammary fold.
RESUMEN
PURPOSE/OBJECTIVES: To explore current breast carcinogenesis theories and the possibility of examining breast epithelial cells to confirm steps in the carcinogenic process and the relationship between intraductal sampling techniques and their role in enhanced risk prediction. DATA SOURCES: Published articles, textbooks, and conference proceedings. DATA SYNTHESIS: Examining breast epithelial cells may provide insight into the carcinogenic process while it is occurring. Methods of extracting breast epithelial cells include nipple aspiration, ductal lavage, and periareolar fine-needle aspiration. CONCLUSIONS: Nipple aspiration, ductal lavage, and periareolar fine-needle aspiration are viable means of examining possible precursors to breast tumors. Differentiating between true precursors and benign changes is an important step in breast cancer risk assessment. IMPLICATIONS FOR NURSING: Nipple aspiration and ductal lavage may be performed in an outpatient setting. RNs and advanced practice nurses may perform these procedures and discuss results with patients.