A surgical approach is considered after nonsurgical modalities to treat chronic post-mastectomy pain have been exhausted.
If trigger points identified on a physical exam have not responded to less invasive treatment,the assumption is that a trapped nerve (or multiple nerves) is creating a constant, painful stimulus. These problematic nerve endings may be surgically addressed.
There are several surgical options for treatment of entrapped, scarred, or abnormal nerve endings. The initial steps involve surgical identification of the problem site and release of the nerve until a normal segment is reached.
At this point, the abnormal nerve ending is removed. The freshly cut nerve ending is then managed by one of three methods:
- “replantation” into surrounding body tissue
- “capping” using a special nerve cap
- “reconnection” to a nerve graft
Nonsurgical pre-and-post-operative modalities are applied as part of the multidisciplinary protocols to reduce the risk of formation or recurrence of pain issues.