Breast and Chest Wall Pain

When you are experiencing burning, searing, electric, sharp pain in your breast or chest wall after you have had a surgical procedure or physical trauma to the region and other doctors or health care providers are unable to either diagnose the root cause or address the problem, Dr. Eric H. Williams may be able to help.Happy woman walking dog

Before we get further into this topic, it is extremely important to note that chest pain can have serious causes. Any new, severe, or persisting chest pain should be discussed with your primary physician first. This is particularly important if you are an adult and have a history of heart or lung disease. If the pain is particularly severe, especially if radiating to your arms or jaw, and you feel sick, sweaty or breathless, call 911 – these can be symptoms of a heart attack.

Breast and Chest Wall

The type of pain that Dr. Williams has been treating for the past several years, and the subject of this web page, is most often described by patients as a burning, searing, electric, or sharp pain in your breast or chest wall after you have had a surgical procedure or physical trauma to the region. 

The most common patients to experience this are women who survived their fight with breast cancer and are now cancer-free but now have these terrible symptoms that severely limit their enjoyment and lifestyle after their surgery and treatment for their cancer.

Breast cancer survivors are very fortunate indeed to have survived the disease, as so many are not. However, all their doctors seem to say to them is “I am sorry that you are hurting so much, but you should be thankful that you are alive.”  

Now, these women are certainly all thankful to be alive, but there’s also frustration in the fact their lives feel robbed somehow. They may have elected breast reconstruction or not to have reconstruction, or perhaps they didn’t even need it because they had only a lumpectomy (removal of small part of breast) instead of a mastectomy (removal). Depending on the case, they may have had a radical lymph node dissection or a “sentinel node” dissection. Radiation therapy might have been in the picture. These women will also often have a very acceptable cosmetic appearance reconstruction (if they had one). But somehow very few of these women are ever asked if they have chronic pain.  

In the rare instances they are actually asked, they are appropriately sent to physical therapy for a few months. But what happens if they do not get better?

The 1-year anniversary comes and “Congratulations, you’re alive!” or “Congratulations, your breasts look great.” Often these patients report being frustrated because no one really takes them seriously when they do have the courage to even tell someone they are still having life-limiting, severe pain. Pain that actually interferes with their life every single day. They can hardly get the words out:

  • “But why does the inside of my arm burn so much?”
  • “But why does my nipple hurt so badly – and I don’t even have a nipple anymore?”
  • “Why does my armpit feel like it is on fire all day long?”
  • “Why does the side of my chest feel like someone is raking pins across it 24 hours a day?”   

Dr. Williams has been working a small group of these patients over the past few years to try to diagnose and treat those patients that have been refractory to the medical care that is offered. All of these patients are well past their 6th month anniversary. Most have been suffering for over 2 years.   

All of them have, appropriately, gone through several rounds of physical therapy. Physical therapy does help many women and should not be underestimated. This is the first most-appropriate treatment for nerve pain after breast cancer surgery.

There are many causes of breast and chest wall pain that Dr. Williams does not treat, and many of these patients will improve greatly with expert physical therapy. Dr. Williams does not treat frozen shoulders, stiffness, chest wall radiation burns or injury, improper breast reconstruction, or capsular contractures from implants. 

Post-Surgical and Traumatic Pain in Chest Region

Dr. Williams specializes in the diagnosis and treatment of women and men who have chronic refractory medial arm pain, lateral chest wall, axillary (arm pit), and breast pain caused by nerve injuries that can occur in this surgical or post traumatic patient population. All of these patients have something in common – they have all had surgery or trauma that has cut or stretched branches of the intercostal nerve system.   

The intercostal nerve travels from the spinal cord and then between the ribs to provide sensation to the chest wall from the back of the chest, side of the chest, and front of the chest – including the breast, areola, and nipple. Usually the nerves that can be injured are the intercostal nerves from the 2nd rib to the 5th rib. Not all of them necessarily cause problems. 

In addition to the intercostal nerves, the intercosto-brachial cutaneous nerve can be involved, and we have seen patients who have had involvement of the medial brachial cutaneous nerve as well. The latter two branches are more likely to be involved due to lymph node dissections, and not the mastectomy itself. 

It is impossible to remove a breast for cancer, or for any reason for that matter, without cutting every single nerve branch that goes to that breast. Why some women do very well with this operation, and some do so poorly is difficult to know for certain, but there are many factors.

Chronic breast pain after breast surgery is more common than most want to believe. Many of these patients seem to wear it as a badge of honor – perhaps because they had no other choice offered to them. But chronic pain is NOT normal, and, yes, these women deserve the utmost respect for going through hell and back, but severe chronic pain is not the expectation that these patients should live with.  

While many women will have some discomfort for 6 months or more following their breast surgery, many in his group are fortunate enough that it is well-controlled by physical therapy, medications, or activity modification. It might catch them by surprise every once and a while, but it may not ruin their day.  

This page is NOT for those ladies. This page is dedicated to those women (or men) who are afraid to go out because any jostle or touch by a stranger passing by, any bump in the car driving around, any brush of clothing against the breast or chest wall or inner arm is excruciating. These individuals plan their lives around their chest or inner arm, and everyone close to them may do the same as well.

Their mates and children have learned what not to do around them, and if they forget – it is not a happy day for anyone. Physical intimacy may be lost because of pain. Their spouses may have long ago stopped asking the question “how can I help them feel better?” and have switched to “how can I prevent making them worse?” Patients (or their significant others) may have even had to switch sides of the bed, or leave the bed altogether, because of fear of bumping the wrong place while sleeping. 

These patients are frequently on many medications such as Neurontin, Lyrica, Cymbalta, amitriptyline, and much stronger narcotics. They may be missing days at work – if they have even been able to return to work – because they are so tired and foggy-headed from the medications they are taking, and it does not even seem to be working! 

Professional Diagnosis and Treatment

If this sounds like you, Dr. Williams might be able to diagnose which nerves are causing the problems and potentially come up with a treatment plan to try to improve the situation.  

It is important to note that there may be more than one way to injury the intercostal nerves. Dr. Williams specializes in trying to diagnose which nerves are involved in the pain syndrome, then trying to find them, remove them, and place them in a more “protected and safe” environment. This usually entails putting the cut ends into muscle tissue instead of letting them form neuromas (abnormal nerve sprouts) in the skin and fat of the chest wall.  

Dr. Williams will often perform nerve blocks in the office to help tease out the cause and location of these injured nerves. The nerve blocks are expected to temporarily make all (or nearly all) the pain go away. Most of these blocks are done in the office setting. If the nerve blocks don’t help temporarily, then the search must continue to find the cause.  

Dr. Williams has been performing these operations for the past few years. The results from his first series has been encouraging. While not every patient is cured, up to 75-85% of patients have seen good to excellent results. Through this process, we are learning more about who is and is not a good candidate.

Unfortunately, there is not guarantee surgery will be beneficial. Some patients simply do not respond to surgery. Other patients will require more than one attempt to find the problems areas. Some patients will improve but still require various medications to help with their persistent symptoms. Almost all patients will have new scars from surgery. 

Dr. Williams has seen and treated patients with pain after mastectomy with or without node dissection, lumpectomy or biopsy with or without node dissection, breast augmentation, and mastopexy (breast lift). See some of our testimonials to learn about similar patients who have been helped. 

Dr. Williams does not operate on patients with post-herpetic neuralgia – nerve pain after herpes zoster infection. He also does not operate on patients with breast pain and no previous history of trauma to the area or breast surgery.  

When other doctors are unable to determine the source of your chest or breast pain, you should contact our Baltimore, MD office and request a consultation with Dr. Williams. He may be able to identify the root cause of the issue and develop a plan to address it. Contact us today by calling (410) 709-3868 and our staff will be glad to assist you.

Eric H. Williams MD
Specializing in reconstructive surgery and pain relief in the Greater Baltimore area.