Breast Cancer Research and Treatment

, Volume 80, Issue 1, pp 39–48

Pain and Quality of Life after Surgery for Breast Cancer

  • Orazio Caffo
  • Maurizio Amichetti
  • Antonella Ferro
  • Antonio Lucenti
  • Francesco Valduga
  • Enzo Galligioni


Background. In breast cancer (BC) patients, conservative surgery (CS) followed by irradiation or immediate breast reconstruction (IBR) after modified radical mastectomy (MRM) has been proposed in the attempt to avoid the negative impact of MRM on feminine body image. Regardless of the type of operation, BC patients may feel pain even without recurrent disease with poor adjustment in terms of quality of life (QL).

Methods. We adopted a questionnaire comprising the short form of the McGill Pain questionnaire, and a previously validated questionnaire able to identify four subscales exploring physical well-being, physical autonomy, relational life and psychological well-being. The questionnaire was mailed in 1999 to a consecutive series of 757 (CS: 481 cases; MRM + IBR with skin expander: 93 cases; MRM: 183 cases) disease-free patients treated for BC between March 1995 and March 1998.

Results. The final analysis assessed the data relating to 529 patients who underwent axillary dissection. Pain was reported by 39.7% of women with higher incidence in patients who underwent CS than in those who underwent MRM ± IBR, but this difference did not reach statistical significance (p = 0.07). The only statistically significant difference (p < 0.05) between the surgical groups was the pain appearance that occurred earlier in the CS patients and later in the MRM + IBR patients. No other differences were observed. The women with pain had significantly worse QL scores on all of the subscales than those without.

Conclusion. Pain after surgery for BC distress almost one-third of patients, regardless of the type of treatment, and had a negative effect on patients' QL. The different surgical procedures may marginally influence the quantitative characteristics of pain.

breast cancer breast reconstruction conservative surgery mastectomy pain quality of life 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Noone RB, Frazier TG, Hayward CZ, Skiles MS: Patient acceptance of immediate reconstruction following mastectomy. Plast Reconstr Surg 69: 632-640, 1982Google Scholar
  2. 2.
    Dean C, Chetty U, Forrest APM: Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet 459-462, 1983Google Scholar
  3. 3.
    Veronesi U, Luini A, Galimberti V, Zurrida S: Conservation approaches for the management of stage I/II carcinoma of the breast: Milan cancer Institute Trials. World J Surg 18: 70-75, 1994Google Scholar
  4. 4.
    Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM: Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. New Engl J Med 333: 1456-1461, 1995Google Scholar
  5. 5.
    Karydas I, Fentiman IS, Habib F, Hayward JL: Sensory changes after treatment of operable breast cancer. Breast Cancer Res Treat 8: 55-59, 1986Google Scholar
  6. 6.
    Vecht CJ, van de Brand HJ, Wajer OM: Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve. Pain 38: 171-176, 1989Google Scholar
  7. 7.
    Tasmuth T, Kataja M, Blomqvist C, von Smitten K, Kalso E: Treatment-related factors predisposing to chronic pain in patients with breast cancer-a multivariate approach. Acta Oncol 36: 625-630, 1997Google Scholar
  8. 8.
    Huang TT: Breast and subscapular pain following submuscular placement of breast prostheses. Plast Reconstr Surg 86: 275-280, 1990Google Scholar
  9. 9.
    Amichetti M, Busana L, Caffo O: Long-term cosmetic outcome and toxicity in patients treated with quadrantectomy and radiation therapy for early stage breast cancer. Oncology 52: 177-181, 1995Google Scholar
  10. 10.
    Amichetti M, Caffo O, Arcicasa M, Roncadin M, Lora O, Rigon A, Zini G, Armaroli L, Coghetto F, Zorat P, Neri S, Teodorani N: Quality of life in patients with ductal carcinoma in situ of the breast treated with conservative surgery and postoperative irradiation. Breast Cancer Res Treat 54: 109-115, 1999Google Scholar
  11. 11.
    Amichetti M, Caffo O: Quality of life in patients with early stage breast carcinoma treated with conservation surgery and radiotherapy. An Italian monoinstitutional study. Tumori 87: 78-84, 2001Google Scholar
  12. 12.
    Thirlaway K, Fallowfield L, Cuzick J: The sexual activity questionnaire: a measure of women's sexual functioning. Qual Life Res 5: 81-90, 1996Google Scholar
  13. 13.
    Melzack R: The short-form McGill Pain Questionnaire. Pain 30: 191-197, 1987Google Scholar
  14. 14.
    Reaby LL, Hort LK: Postmastectomy attitudes of women who wear external breast prostheses compared to those who have undergone breast reconstructions. J Behav Med 18: 55-67, 1995Google Scholar
  15. 15.
    McCormick B, Yahalom J, Cox L, Shank B, Massie MJ: The patients perception of her breast following radiation and limited surgery. Int J Radiat Oncol Biol Phys 17: 1299-1302, 1989Google Scholar
  16. 16.
    Katz J, Melzack R: Measurement of pain. Anesthesiol Clin North Am 10: 229-246, 1992Google Scholar
  17. 17.
    Dudgeon D, Raubertas RF, Rosenthal SN: The short-form McGill Pain Questionnaire in chronic cancer pain. J Pain Symptom Manage 8: 191-195, 1993Google Scholar
  18. 18.
    Hack TF, Cohen L, Katz J, Robson LS, Goss P: Physical and psychological morbidity after axillary lymph node dissection for breast cancer. J Clin Oncol 17: 143-149, 1999Google Scholar
  19. 19.
    Maiani G, Sanavio E: Semantics of pain in Italy: the Italian version of the McGill Pain Questionnaire. Pain 22: 399-405, 1985Google Scholar
  20. 20.
    Strang P: Cancer pain: a provoker of emotional, social and existential distress. Acta Oncol 37: 641-644, 1998Google Scholar
  21. 21.
    Gerber L, Lampert M, Wood C, Duncan M, D'Angelo T, Schain WS, McDonald H, Danforth D, Findlay P, Glatstein E: Comparison of pain, motion, and edema after modified radical mastectomy vs. local excision with axillary dissection and radiation. Breast Cancer Res Treat 21: 139-145, 1992Google Scholar
  22. 22.
    Keramopoulos A, Tsionou C, Minaretzis D, Michalas S, Aravantinos D: Arm morbidity following treatment of breast cancer with total axillary dissection: a multivariated approach. Oncology 50: 445-449, 1993Google Scholar
  23. 23.
    Tasmuth T, von Smitten K, Hietanen P, Kataja M, Kalso E: Pain and other symptoms after different treatment modalities of breast cancer. Ann Oncol 6: 453-459, 1995Google Scholar
  24. 24.
    Kuehn T, Klauss W, Darsow M, Regele S, Flock F, Maiterth C, Dahlbender R, Wendt I, Kreienberg R: Long-term morbidity following axillary dissection in breast cancer patients-clinical assessment, significance for life quality and the impact of demographic, oncologic and therapeutic factors. Breast Cancer Res Treat 64: 275-286, 2000Google Scholar
  25. 25.
    Karydas I, Fentiman IS, Habib F, Hayward JL: Sensory changes after treatment of operable breast cancer. Breast Cancer Res Treat 8: 55-59, 1986Google Scholar
  26. 26.
    Wallace MS, Wallace AM, Lee J, Dobke MK: Pain after breast surgery: a survey of 282 women. Pain 66: 195-205, 1996Google Scholar
  27. 27.
    Carpenter JS, Sloan P, Andrykowski MA, McGrath P, Sloan D, Rexford T, Kenady D: Risk factors for pain after mastectomy/ lumpectomy. Cancer Pract 7: 66-70, 1999Google Scholar
  28. 28.
    Rowland JH, Desmond K, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA: Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 92: 1422-1429, 2000Google Scholar
  29. 29.
    Tasmuth T, Kataja M, Blomqvist C, von Smitten K, Kalso E: Treatment-related factors predisposing to chronic pain in patients with breast cancer-a multivariate approach. Acta Oncol 36: 625-630, 1997Google Scholar
  30. 30.
    Warmuth MA, Bowen G, Prosnitz LR, Chu L, Broadwater G, Peterson B, Leight G, Winer EP: Complications of axillary lymph node dissection for carcinoma of the breast. Cancer 83: 1362-1368, 1998Google Scholar
  31. 31.
    Liljegren G, Holmberg L: Armmorbidity after sector resection and axillary dissection with or without postoperative radiotherapy in breast cancer stage. I. Results from a randomised trial. Eur J Cancer 33: 193-199, 1997Google Scholar
  32. 32.
    Olsen NK, Pfeiffer P, Johannsen L, Schroder H, Rose C: Radiation-induced brachial plexopathy: neurological followup in 161 recurrence-free breast cancer patients. Int J Radiat Oncol Biol Phys 26: 43-49, 1993Google Scholar
  33. 33.
    Pierce SM, Recht A, Lingos TI, Abner A, Vicini F, Silver B, Herzog A, Harris JR: Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer. Int J Radiat Oncol Biol Phys 23: 915-923, 1992Google Scholar
  34. 34.
    Smith WC, Bourne D, Squair J, Phillips O, Alastair CW: A retrospective cohort study of postmastectomy pain syndrome. Pain 83: 91-95, 1999Google Scholar
  35. 35.
    Johansen J, Overgaard J, Blichert-Toft M, Overgaard M: Treatment of morbidity associated with the management of the axilla in breast-conserving therapy. Acta Oncol 39: 349-354, 2000Google Scholar
  36. 36.
    Maunsell E, Brisson J, Deschenes L: Arm problems and psychological distress after surgery for breast cancer. Can J Surg 36: 315-320, 1993Google Scholar
  37. 37.
    Tasmuth T, von Smitten K, Kalso E: Pain and other symptoms during the first year after radical and conservative surgery for breast cancer. Br J Cancer 74: 2024-2031, 1996Google Scholar
  38. 38.
    Stanton AL, Krishnan L, Collins CA: Form or function? Part 1. Subjective cosmetic and functional correlates of quality of life in women treated with breast-conserving procedures and radiotherapy. Cancer 91: 2273-2281, 2001Google Scholar
  39. 39.
    Krishnan L, Stanton AL, Collins CA, Liston VE, Jewell WR: Form or function? Part 2. Objective cosmetic and functional correlates of quality of life in women treated with breast-conserving procedures and radiotherapy. Cancer 91: 2282-2287, 2001Google Scholar
  40. 40.
    Irwig L, Bennetts A: Quality of life after breast conservation or mastectomy: a systematic review. ANZ J Surg 67: 750-754, 1997Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Orazio Caffo
    • 1
  • Maurizio Amichetti
    • 2
  • Antonella Ferro
    • 1
  • Antonio Lucenti
    • 1
  • Francesco Valduga
    • 1
  • Enzo Galligioni
    • 1
  1. 1.Department of Medical OncologySanta Chiara HospitalTrentoItaly
  2. 2.Department of RadiotherapyOspedale Oncologico “Businco”CagliariItaly

Personalised recommendations