Intercostal Regenerative Peripheral Nerve Interface for the Prevention of Neuroma-Associated Post Breast Surgery Pain Syndrome in Breast Reconstruction: A Proof-of-Concept Study

Post-breast surgery pain syndrome (PBSPS) represents chronic, persistent pain after breast surgery, which occurs in 13-60% of patients. Intercostal neuroma formation is one cause of PBSPS. Treatment of neuroma-related PBSPS with regenerative peripheral nerve interfaces (RPNI) has been demonstrated, however, prevention of PBSPS has not.

To evaluate if intercostal nerve RPNI prevents PBSPS in patients undergoing mastectomy with breast reconstruction.

Consecutive patients who underwent a mastectomy and breast reconstruction with intercostal nerve RPNI attempted were included. RPNI was performed using a nearby pectoralis, intercostal, or serratus muscle graft. The primary outcome was postoperative intercostal neuroma-related PBSPS. This was defined by pain with location on the lateral chest wall, neuropathic quality, moderate severity, presence >50% of the time, and for >6 months.

Twelve patients (19 breasts) were included. Median age was 54.7 years. Intercostal nerve RPNI was attempted for each breast and was achieved in 17 of 19 breasts (89.5%). In two breasts, no intercostal nerve could be identified. Surveys were completed by nine patients (75.0%). One patient, with unilateral reconstruction, developed PBSPS (5.3% [1/19] of mastectomies, 8.3% [1/12] of patients). Complications included surgical site cellulitis in 5.3% (1/19 breasts) and seroma in 31.6% (6/19 breasts). Median follow-up period was 19.0 months.

We report a low rate of intercostal neuroma-related PBSPS after prophylactic intercostal RPNI. Due to our small sample size, further study is required to determine the contribution of neuroma formation to the overall incidence of PBSPS, and the efficacy of RPNI to prevent it.