Skip to main content
SpringerLink
Log in

Long-Term Complications and Management

  • Chapter
  • First Online:
Breast Disease

  • 890 Accesses

Abstract

As with all surgical and medical procedures, the sequela of an intervention will have some impact on the body. For women with breast cancer, treatment can often include a spectrum of modalities such as surgery, radiation therapy, or systemic chemotherapy, and fortunately, most sequelae are short-lived. However, some problems persist and become a chronic, life-altering, and quality-of-life diminishing issue that often is either ignored or not treated, secondary to the unawareness of the condition.

These problems can run the range of chronic postoperative pain, seroma formation, and poor cosmesis. This chapter attempts to provide a basic understanding of some of the most frequently encountered chronic problems after breast cancer treatment with hypothesis for potential causes and some suggestions for management.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg. 2007;245(5):665–71.

    Article  PubMed  PubMed Central  Google Scholar 

  2. de Blacam C, Ogunleye AA, Momoh AO, et al. High body mass index and smoking predict morbidity in breast cancer surgery: a multivariate analysis of 26,988 patients from the national surgical quality improvement program database. Ann Surg. 2012;255(3):551–5.

    Article  PubMed  Google Scholar 

  3. Dunne M, Keenan K. CE: late and long-term sequelae of breast cancer treatment. Am J Nurs. 2016;116(6):36–45.

    Article  PubMed  Google Scholar 

  4. Poleshuck EL, Katz J, Andrus CH, et al. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain. 2006;7(9):626–34.

    Article  PubMed  Google Scholar 

  5. Meijuan Y, Zhiyou P, Yuwen T, Ying F, Xinzhong C. A retrospective study of postmastectomy pain syndrome: incidence, characteristics, risk factors, and influence on quality of life. Sci World J. 2013;2013:159732.

    Article  Google Scholar 

  6. Ferreira VT, Dibai-Filho AV, Kelly de Oliveira A, Gomes CA, Melo ES, Maria de Almeida A. Assessing the impact of pain on the life of breast cancer survivors using the Brief Pain Inventory. J Phys Ther Sci. 2015;27(5):1361–3.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ferreira VT, Guirro EC, Dibai-Filho AV, Ferreira SM, de Almeida AM. Characterization of chronic pain in breast cancer survivors using the McGill Pain Questionnaire. J Bodyw Mov Ther. 2015;19(4):651–5.

    Article  PubMed  Google Scholar 

  8. Schreiber KL, Kehlet H, Belfer I, Edwards RR. Predicting, preventing and managing persistent pain after breast cancer surgery: the importance of psychosocial factors. Pain Manage. 2014;4(6):445–59.

    Article  Google Scholar 

  9. Vilholm OJ, Cold S, Rasmussen L, Sindrup SH. The postmastectomy pain syndrome: an epidemiological study on the prevalence of chronic pain after surgery for breast cancer. Br J Cancer. 2008;99(4):604–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Bokhari FN, McMillan DE, McClement S, Daeninck PJ. Pilot study of a survey to identify the prevalence of and risk factors for chronic neuropathic pain following breast cancer surgery. Oncol Nurs Forum. 2012;39(2):E141–9.

    Article  PubMed  Google Scholar 

  11. Vadivelu N, Schreck M, Lopez J, Kodumudi G, Narayan D. Pain after mastectomy and breast reconstruction. Am Surg. 2008;74(4):285–96.

    PubMed  Google Scholar 

  12. Beyaz SG, Ergonenc JS, Ergonenc T, Sonmez OU, Erkorkmaz U, Altintoprak F. Postmastectomy pain: a cross-sectional study of prevalence, pain characteristics, and effects on ouality of life. Chin Med J. 2016;129(1):66–71.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mejdahl MK, Andersen KG, Gartner R, Kroman N, Kehlet H. Persistent pain and sensory disturbances after treatment for breast cancer: six year nationwide follow-up study. BMJ (Clinical Research ed). 2013;346:f1865.

    Google Scholar 

  14. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581–624.

    Article  PubMed  Google Scholar 

  15. Crane-Okada R, Wascher RA, Elashoff D, Giuliano AE. Long-term morbidity of sentinel node biopsy versus complete axillary dissection for unilateral breast cancer. Ann Surg Oncol. 2008;15(7):1996–2005.

    Article  PubMed  Google Scholar 

  16. Rietman JS, Dijkstra PU, Geertzen JH, et al. Treatment-related upper limb morbidity 1 year after sentinel lymph node biopsy or axillary lymph node dissection for stage I or II breast cancer. Ann Surg Oncol. 2004;11(11):1018–24.

    Article  CAS  PubMed  Google Scholar 

  17. Taira N, Shimozuma K, Ohsumi S, et al. Impact of preservation of the intercostobrachial nerve during axillary dissection on sensory change and health-related quality of life 2 years after breast cancer surgery. Breast Cancer (Tokyo, Japan). 2014;21(2):183–90.

    Article  Google Scholar 

  18. Andersen KG, Aasvang EK, Kroman N, Kehlet H. Intercostobrachial nerve handling and pain after axillary lymph node dissection for breast cancer. Acta Anaesthesiol Scand. 2014;58(10):1240–8.

    Article  CAS  PubMed  Google Scholar 

  19. Langford DJ, Paul SM, West C, et al. Persistent arm pain is distinct from persistent breast pain following breast cancer surgery. J Pain. 2014;15(12):1238–47.

    Article  PubMed  PubMed Central  Google Scholar 

  20. De Oliveira GS, Bialek JM Jr, Nicosia L, et al. Lack of association between breast reconstructive surgery and the development of chronic pain after mastectomy: a propensity maached retrospective cohort analysis. Breast. 2014;23(4):329–33.

    Article  PubMed  Google Scholar 

  21. Glare PA, Davies PS, Finlay E, et al. Pain in cancer survivors. J Clin Oncol. 2014;32(16):1739–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Katz J, Seltzer Z. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert Rev Neurother. 2009;9(5):723–44.

    Article  PubMed  Google Scholar 

  23. Rojas KE, Manasseh DM, Flom PL, et al. A pilot study of a breast surgery Enhanced Recovery After Surgery (ERAS) protocol to eliminate narcotic prescription at discharge. Breast Cancer Res Treat. 2018;171(3):621–6.

    Article  PubMed  Google Scholar 

  24. Chiu C, Aleshi P, Esserman LJ, et al. Improved analgesia and reduced post-operative nausea and vomiting after implementation of an enhanced recovery after surgery (ERAS) pathway for total mastectomy. BMC Anesthesiol. 2018;18(1):41.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17:131–57.

    Article  PubMed  Google Scholar 

  26. Gritsenko K, Khelemsky Y, Kaye AD, et al. Multimodal therapy in perioperative analgesia. Best Pract Res Clin Anaesthesiol. 2014;28:59–79.

    Article  PubMed  Google Scholar 

  27. Kumar S, Lal B, Misra MC. Post-mastectomy seroma: a new look into the aetiology of an old problem. J R Coll Surg Edinb. 1995;40(5):292–4.

    CAS  PubMed  Google Scholar 

  28. Agrawal A, Ayantunde AA, Cheung KL. Concepts of seroma formation and prevention in breast cancer surgery. ANZ J Surg. 2006;76(12):1088–95.

    Article  PubMed  Google Scholar 

  29. Gonzalez EA, Saltzstein EC, Riedner CS, Nelson BK. Seroma formation following breast cancer surgery. Breast J. 2003;9(5):385–8.

    Article  PubMed  Google Scholar 

  30. Turner EJ, Benson JR, Winters ZE. Techniques in the prevention and management of seromas after breast surgery. Future Oncol (London, England). 2014;10(6):1049–63.

    Article  CAS  Google Scholar 

  31. Purushotham AD, Upponi S, Klevesath MB, et al. Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. J Clin Oncol. 2005;23(19):4312–21.

    Article  PubMed  Google Scholar 

  32. Zielinski J, Jaworski R, Irga N, Kruszewski JW, Jaskiewicz J. Analysis of selected factors influencing seroma formation in breast cancer patients undergoing mastectomy. Arch Med Sci: AMS. 2013;9(1):86–92.

    Article  CAS  PubMed  Google Scholar 

  33. van Bemmel AJ, van de Velde CJ, Schmitz RF, Liefers GJ. Prevention of seroma formation after axillary dissection in breast cancer: a systematic review. Eur J Surg Oncol. 2011;37(10):829–35.

    Article  PubMed  Google Scholar 

  34. Srivastava V, Basu S, Shukla VK. Seroma formation after breast cancer surgery: what we have learned in the last two decades. J Breast Cancer. 2012;15(4):373–80.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Porter KA, O’Connor S, Rimm E, Lopez M. Electrocautery as a factor in seroma formation following mastectomy. Am J Surg. 1998;176(1):8–11.

    Article  CAS  PubMed  Google Scholar 

  36. Yilmaz KB, Dogan L, Nalbant H, et al. Comparing scalpel, electrocautery and ultrasonic dissector effects: the impact on wound complications and pro-inflammatory cytokine levels in wound fluid from mastectomy patients. J Breast Cancer. 2011;14(1):58–63.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Currie A, Chong K, Davies GL, Cummins RS. Ultrasonic dissection versus electrocautery in mastectomy for breast cancer - a meta-analysis. Eur J Surg Oncol. 2012;38(10):897–901.

    Article  CAS  PubMed  Google Scholar 

  38. Iovino F, Auriemma PP, Ferraraccio F, Antoniol G, Barbarisi A. Preventing seroma formation after axillary dissection for breast cancer: a randomized clinical trial. Am J Surg. 2012;203(6):708–14.

    Article  PubMed  Google Scholar 

  39. Lefemine V, Cornish JA, Abou-Samra W. Argon beam coagulator in breast surgery: effect on the incidence of breast seroma. Surg Tec Int. 2011;21:97–100.

    Google Scholar 

  40. Wyman A, Rogers K. Randomized trial of laser scalpel for modified radical mastectomy. Br J Surg. 1993;80(7):871–3.

    Article  CAS  PubMed  Google Scholar 

  41. Wyman A, Rogers K. Radical breast surgery with a contact Nd:YAG laser scalpel. Eur J Surg Oncol. 1992;18(4):322–6.

    CAS  PubMed  Google Scholar 

  42. Huang J, Yu Y, Wei C, Qin Q, Mo Q, Yang W. Harmonic scalpel versus electrocautery dissection in modified radical mastectomy for breast cancer: a meta-analysis. PLoS One. 2015;10(11):e0142271.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. Khan S, Khan S, Chawla T, Murtaza G. Harmonic scalpel versus electrocautery dissection in modified radical mastectomy: a randomized controlled trial. Ann Surg Oncol. 2014;21(3):808–14.

    Article  PubMed  Google Scholar 

  44. Almond LM, Khodaverdi L, Kumar B, Coveney EC. Flap anchoring following primary breast cancer surgery facilitates early hospital discharge and reduces costs. Breast Care (Basel, Switzerland). 2010;5(2):97–101.

    Article  Google Scholar 

  45. Mazouni C, Mesnard C, Cloutier AS, et al. Quilting sutures reduces seroma in mastectomy. Clin Breast Cancer. 2015;15(4):289–93.

    Article  PubMed  Google Scholar 

  46. ten Wolde B, van den Wildenberg FJ, Keemers-Gels ME, Polat F, Strobbe LJ. Quilting prevents seroma formation following breast cancer surgery: closing the dead space by quilting prevents seroma following axillary lymph node dissection and mastectomy. Ann Surg Oncol. 2014;21(3):802–7.

    Article  PubMed  Google Scholar 

  47. Sakkary MA. The value of mastectomy flap fixation in reducing fluid drainage and seroma formation in breast cancer patients. World J Surg Oncol. 2012;10:8.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kottayasamy Seenivasagam R, Gupta V, Singh G. Prevention of seroma formation after axillary dissection--a comparative randomized clinical trial of three methods. Breast J. 2013;19(5):478–84.

    PubMed  Google Scholar 

  49. Faisal M, Abu-Elela ST, Mostafa W, Antar O. Efficacy of axillary exclusion on seroma formation after modified radical mastectomy. World J Surg Oncol. 2016;14(1):39.

    Article  PubMed  PubMed Central  Google Scholar 

  50. O’Hea BJ, Ho MN, Petrek JA. External compression dressing versus standard dressing after axillary lymphadenectomy. Am J Surg. 1999;177(6):450–3.

    Article  PubMed  Google Scholar 

  51. Qvamme G, Axelsson CK, Lanng C, et al. Randomized clinical trial of prevention of seroma formation after mastectomy by local methylprednisolone injection. Br J Surg. 2015;102(10):1195–203.

    Article  CAS  PubMed  Google Scholar 

  52. Burak WE Jr, Goodman PS, Young DC, Farrar WB. Seroma formation following axillary dissection for breast cancer: risk factors and lack of influence of bovine thrombin. J Surg Oncol. 997;64(1):27–31.

    Article  CAS  PubMed  Google Scholar 

  53. Benevento R, Santoriello A, Pellino G, et al. The effects of low-thrombin fibrin sealant on wound serous drainage, seroma formation and length of postoperative stay in patients undergoing axillary node dissection for breast cancer. A randomized controlled trial. Inter J Surg (London, England). 2014;12(11):1210–5.

    Article  Google Scholar 

  54. Yang Y, Gao E, Liu X, et al. Effectiveness of OK-432 (Sapylin) to reduce seroma formation after axillary lymphadenectomy for breast cancer. Ann Surg Oncol. 2013;20(5):1500–4.

    Article  PubMed  Google Scholar 

  55. Shamley DR, Barker K, Simonite V, Beardshaw A. Delayed versus immediate exercises following surgery for breast cancer: a systematic review. Breast Cancer Res Treat. 2005;90(3):263–71.

    Article  PubMed  Google Scholar 

  56. Petito EL, Esteves MT, Elias S, Facina G, Nazario AC, Gutierrez MG. The influence of the initiation of an exercise programme on seroma formation and dehiscence following breast cancer surgery. J Clin Nurs. 2014;23(21–22):3087–94.

    Article  PubMed  Google Scholar 

  57. Cinar N, Seckin U, Keskin D, Bodur H, Bozkurt B, Cengiz O. The effectiveness of early rehabilitation in patients with modified radical mastectomy. Cancer Nurs. 2008;31(2):160–5.

    Article  PubMed  Google Scholar 

  58. He XD, Guo ZH, Tian JH, Yang KH, Xie XD. Whether drainage should be used after surgery for breast cancer? A systematic review of randomized controlled trials. Med Oncol (Northwood, London, England). 2011;28(Suppl 1):S22–30.

    Article  Google Scholar 

  59. Thomson DR, Sadideen H, Furniss D. Wound drainage after axillary dissection for carcinoma of the breast. Cochrane Database Syst Rev. 2013;10:CD006823.

    Google Scholar 

  60. Taylor JC, Rai S, Hoar F, Brown H, Vishwanath L. Breast cancer surgery without suction drainage: the impact of adopting a ‘no drains’ policy on symptomatic seroma formation rates. Eur J Surg Oncol. 2013;39(4):334–8.

    Article  CAS  PubMed  Google Scholar 

  61. Okada N, Narita Y, Takada M, et al. Early removal of drains and the incidence of seroma after breast surgery. Breast Cancer (Tokyo, Japan). 2015;22(1):79–83.

    Article  Google Scholar 

  62. Stanczyk M, Grala B, Zwierowicz T, Maruszynski M. Surgical resection for persistent seroma, following modified radical mastectomy. World J Surg Oncol. 2007;5:104.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Catsman CJ, Beek MA, Rijken AM. Talc seromadesis in patients with chronic seroma formation after breast surgery. Springer Plus. 2016;5:3.

    Article  PubMed  Google Scholar 

  64. Saeb-Parsy K, Athanassoglou V, Benson JR. Talc seromadesis: a novel technique for the treatment of chronic seromas following breast surgery. Breast J. 2006;12(5):502–4.

    Article  PubMed  Google Scholar 

  65. Bi H, Fang S, Jiang D, et al. Ultrasound-guided scraping of fibrous capsule plus bilayered negative pressure wound therapy for treatment of refractory postmastectomy seroma. J Plast Reconstr Aesthet Surg: JPRAS. 2015;68(3):403–9.

    Article  PubMed  Google Scholar 

  66. Wickerham D, Anderson S, Fisher B, Margolese R, Mamounas T, Wolmark N. NSABP Protocol B-06: A randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer — Results after 15 years of follow-up. Eur J Cancer. 1998;34:S38.

    Article  Google Scholar 

  67. Arndt V, Stegmaier C, Ziegler H, Brenner H. Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: a population-based study. J Cancer Res Clin Oncol. 2008;134(12):1311–8.

    Article  PubMed  Google Scholar 

  68. Negenborn VL, Volders JH, Krekel NMA, Haloua MH, Bouman MB, Buncamper ME, et al. Breast-conserving therapy for breast cancer: cosmetic results and options for delayed reconstruction. J Plast Reconstr Aesthet Surg. 2017;70:1336–44.

    Article  PubMed  Google Scholar 

  69. Ozmen T, Polat AV, Polat AK, Bonaventura M, Johnson R, Soran A. Factors affecting cosmesis after breast conserving surgery without oncoplastic techniques in an experienced comprehensive breast center. Surgeon. 2013;13:39–44.

    Google Scholar 

  70. Matory WE Jr, Wertheimer M, Fitzgerald TJ, Walton RL, Love S. Aesthetic results following partial mastectomy and radiation therapy. Plast Reconstr Surg. 1990;85:739–46.

    Article  PubMed  Google Scholar 

  71. van Turnhout AA, Fuchs S, Lisabeth-Brone K, Vriens-Nieuwenhuis EJC, van der Sluis WB. Surgical outcome and cosmetic results of autologous fat grafting after breast conserving surgery and radiotherapy for breast cancer: a retrospective cohort study of 222 fat grafting sessions in 109 patients. Aesthert Plast Surg. 2017:1334–41.

    Google Scholar 

  72. Vrieling C, Collette L, Fourquet A, Hoogenraad W, Horiot J, Jager J, Pierart M, Poortmans P, Struikmans H, Maat B, Van Limbergen E, Bartelink H. The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC ‘boost vs. no boost’ trial. Radiother Oncol. 2000;55(3):219–32.

    Article  CAS  PubMed  Google Scholar 

  73. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–106.

    Article  CAS  PubMed  Google Scholar 

  74. Brouwers PJAM, van Werkhoven E, Bartelink H, Fourquet A, Lemanski C, van Loon J, et al. Predictors for poor cosmetic outcome in patients with early stage breast cancer treated with breast conserving therapy: results of the Young boost trial. Radiother Oncol. 2018;128(3):434–41.

    Article  PubMed  Google Scholar 

  75. Smith ML, Molina BJ, Dayan E, Jablonka EM, Okwali M, Kim JN, et al. Defining the role of free flaps in partial breast reconstruction. J Reconstr Microsurg. 2018;34(3):185–92.

    Article  PubMed  Google Scholar 

  76. Menekse E, Ozyazici S, Karateke F, Turan U, Kuvvetli A, Gokler C, et al. Rhomboid flap technique in breast-conserving surgery: an alternative method for the reconstruction of lumpectomy defects. J Breast Health. 2015;11(4):186–91.

    Article  PubMed  PubMed Central  Google Scholar 

  77. van Paridon M, Kamali P, Paul M, Wu W, Ibrahim A, Kansal K, Houlihan M, Morris D, Lee B, Lin S, Sharma R. Oncoplastic breast surgery: achieving oncological and aesthetic outcomes. J Surg Oncol. 2017;116(2):195–202.

    Article  PubMed  Google Scholar 

  78. Berry M, Fitoussi A, Curnier A, Couturaud B, Salmon R. Oncoplastic breast surgery: a review and systematic approach. J Plast Reconstr Aesthet Surg. 2010;63(8):1233–43.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Lehigh Valley Health Network, Allentown, PA, USA

    Megan Wardak

  2. University of Pittsburgh Magee-Womens Hospital, Pittsburgh, PA, USA

    Emilia J. Diego

Authors
  1. Megan Wardak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emilia J. Diego
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emilia J. Diego .

Editor information

Editors and Affiliations

  1. Oncology Institute, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

    Adnan Aydiner

  2. Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

    Abdullah Igci

  3. Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Magee-Women’s Hospital of UPMC, Pittsburgh, PA, USA

    Atilla Soran

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Wardak, M., Diego, E.J. (2019). Long-Term Complications and Management. In: Aydiner, A., Igci, A., Soran, A. (eds) Breast Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-16792-9_50

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16792-9_50

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16791-2

  • Online ISBN: 978-3-030-16792-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation