Coping with Pain after Breast Cancer Surgery

By Marijke Vroomen Durning,

Tuesday, July 28, 2015

A patient does strength-training exercises as a physical therapist looks on.

Nearly half of all women experience pain or physical limitations after breast cancer surgery, a condition known as postmastectomy reconstruction syndrome, or PMRS. However, many women find relief with treatments that include medication, physical or occupational therapy, and lymphedema therapy.

  • PMRS is a common side effect of surgery and other treatments for breast cancer.
  • A physiatrist can best diagnose the condition and recommend treatment.
  • Weakness, tightness, pain, or muscle loss in the chest wall are common signs.
  • Treatment for PMRS varies according to symptoms.

After undergoing breast cancer surgery, many women experience lasting pain or discomfort in the breast or chest area. Called postmastectomy reconstruction syndrome (PMRS), this condition is a reality for up to half of women who have breast cancer surgery.

“We use the term postmastectomy reconstruction syndrome to describe specific symptoms that some women may experience after treatment for breast cancer,” explains Memorial Sloan Kettering physiatrist Katarzyna Ibanez.

Physiatrists are doctors who specialize in rehabilitation medicine. MSK has a team of rehab specialists dedicated to caring for people with cancer.

Although the name implies that only women who have undergone mastectomy (surgical removal of the breast and underlying tissue) experience PMRS, the symptoms may be caused by a number of treatments for breast cancer: surgery, lymph node biopsy, reconstruction, chemotherapy, or radiation.

“Whatever the cause, treatment and management are essential so women can get back to their lives in the most comfortable way possible,” Dr. Ibanez says.

A Range of Symptoms

Women with PMRS may experience weakness, tightness, or pain in the shoulder; muscle loss in the chest wall; or muscle spasms and pain. Some women say they have trouble taking a deep breath, comparing the sensation to wearing an “iron bra,” Dr. Ibanez explains.

Other signs include:

  • swelling of the chest wall
  • sensitivity to touch on the chest wall or armpit
  • restricted range of motion
  • axillary web syndrome (also called cording, in which ropelike tissue structures form under the skin of the arms)
  • breast tightness

These symptoms, which can range from mildly annoying to severely restricting, might not be present right after surgery but can pop up years later.

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Seeking the Right Diagnosis

If you have complaints of pain or discomfort after breast cancer surgery, you may find that it can be hard to get a diagnosis. The surgeon has removed the cancer and the oncologist has done his or her job, but how does the leftover pain get diagnosed and treated?

It's important that women with PMRS understand that this is a real syndrome.
Katarzyna Ibanez
Katarzyna Ibanez Physiatrist

If you think you may have PMRS, make an appointment with a physiatrist in your area, Dr. Ibanez advises. He or she will need to take a detailed medical and functional history. A comprehensive physical exam, which includes seeing how well you can move, may help your doctor determine if there are underlying problems with your nerves, muscles, or other tissues.

Sometimes, blood tests or an imaging test such as an MRI may be needed. A test called an electromyography can help to see if there is abnormal muscle or nerve function in the area.

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Finding the Solution

Treatment for PMRS is as varied as its symptoms are, which means there is no specific intervention that will work for all women.

Rehabilitative treatments may include medication, occupational and physical therapy, and lymphedema therapy.

The mainstay of treatment is a highly specialized physical therapy that reeducates the affected muscles and nerves, improves posture and body awareness, stretches the chest wall muscles, strengthens other muscles, and restores joint and soft tissue mobility.

Pain medications may be effective for some women. Others find relief from botulinum toxin (Botox®) or other injections that may reduce or eliminate painful spasms.

In determining a treatment plan for her patients, Dr. Ibanez says, it’s important for her to know more about their lives. Your doctor should be asking questions like:

  • What kind of activities, hobbies, and sports do you participate in?
  • What type of job do you do?
  • What have you found the most disabling?
  • What activities do you most want to return to, and is there a timeframe or any other factors to keep in mind?

Other factors to take into account are how long the symptoms have been present and what treatments, if any, have already been tried.

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Getting Back to Normal

Many women come to her office seeking help, Dr. Ibanez says, and are relieved to hear that they aren’t alone — and that there is treatment. “It’s important that women with PMRS understand that this is a real syndrome,” she stresses. “There is a physiology to it. There is nerve and muscle damage, atrophy, and a change in biomechanics.”

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With a comprehensive program that can last six, eight, or 12 weeks, followed by a lifelong exercise program to maintain the gains, most women will feel much better. “We can never say 100 percent, but I would say 80 to 90 percent of women see great improvements,” says Dr. Ibanez. She adds that it’s important to continue the exercises after the completion of therapy, because symptoms may return or worsen.

“My patients say that life isn’t the same as before cancer treatment, but it’s better than when they first came to see me,” she notes. “They can participate in activities like yoga and swimming, and they can lift their child or grandchild.”

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For those dealing with breast cancer surgery stay strong for your family, friends, loved ones, and yourself!

Patients can contact a certified Cancer Exercise Specialist thru the Cancer Exercise Training Institute's website, and/or a massage therapist who does manual lymphatic drainage by going to the Society for Oncology Massage website

Its been 2 years since my double mastectomy. I had gone back to work thinking it will get better but im finding it harder to deal with the pain and swollen fingers. I am now experiencing muscle spasms. I am disapointted with my primary Dr. for not being able to connect with my real pain. I have worked for the same department for over 25 years and now im unable to do the job. Its heart breaking not being able to find the Dr to help me.

Abby, we're sorry to hear that you're going through this. We recommend that you ask your surgeon or your primary care doctor to refer to to a physiatrist, who may be able to help you with some of the side effects you're experiencing. Physiatrists are medical doctors who specialize in pain and mobility issues related to surgery or injury. Best wishes to you.

HER2+ IDC stage IIB
I had 5 rounds of chemo, refused #6 due to debilitating side effects. Followed by right masectomy involving 2 lymph nodes under my arm with expander. 6 weeks later expander removal and more tissue due to infection. Next came radiation, had my 33rd and final treatment last week, the last 5 being boosts. I have a muscle under my breast that is inflamed and spasms if I use it. It is so very painful I have a hard time catching a breath and lasts long enough to make me break I to a sweat. There is another muscle below that muscle that the radiation didn't hit that does the same thing. I also have other body spasms that are new to me and very painful and frequent. Could a psysiatrist help this and is this a common side effect of my treatments?

We are sorry to hear about the painful side effects you have experienced. If you would like to make an appointment to consult with one of the physiatrists at MSK's Sillerman Rehabilitation Center, please call 646-888-1900. To learn more about the services they provide, please visit Thank you for reaching out to us.

Oh my gosh. It's been two years since my double mastectomy and this is a perfect description of my daily struggle. Pain, tightness, spasms, restricted range of motion. The 'iron bra' syndrome exactly. I've discussed with all 3 of my team; breast surgeon, reconstructive surgeon and oncologist. I've been to physical therapy, sports chiro therapy and massage therapy. The last one is the most helpful in at least unraveling the knots I get from pain and spasms. I will print this and show my doctor next time I go. There has to be some hope.

Dear Cynthia, we are sorry to hear that you've been experiencing the symptoms you described. We hope this information is a helpful resource when you discuss the next steps in your care plan with your doctor.

I just read the IRON BRA wow great description. I thought I was crazy. I am also having trouble getting help with my situation. I live in Indianapolis IN do you know of anyone that can help me in this area? I would appreciate any help!

Kelley, we're sorry to hear that you're experiencing this. We recommend that you ask your doctors for a referral to a physical or occupational therapist who has experience in working with breast cancer patients. Thank you for your comment.

Ten weeks since my bilateral mastectomy and I am still so sore. Luckily I am seeing a PT who has a massage therapist in his practice. Cannot bear the tightness and burning. Hope they can help. This was my idea not my surgeon's or any of her staff. Disappointed that they did not recommend such an important followup. Maybe I am expecting too much too soon but I want to get back to my active self.

Dear Janet, we are sorry to hear that you are still in pain. Everyone recovers differently from surgery but it's important to get the support you need to address your pain. We hope your physical therapist can help with this. Thank you for sharing your thoughts on our blog.

Almost a year post double mastectomy reconstruction 3/14/16. Great to read I am not crazy having this pain and limitations. Range of motion is good - had PT at my suggestion. I have the spasms if I lift things or reach. Definitely showing to my Reconstruction doc, she offered to do surgery again... She Didn't understand why I was still having pain and limitations!!!! Now I know. Thanks

Dear Neva, we are sorry to hear that you are experiencing pain and limited range of motion from your surgery. We are glad to know this information has been helpful. Thank you for sharing your thoughts and experience on our blog.

I had a bilateral mastectomy just one month ago with immediate reconstruction via the use of a prepectoral implant. Overall, I feel great and I am back to work (desk job). Unfortunately, at random times, a wave of tightness takes over my breast area and feels very much like an "iron bra". It is so incredibly uncomfortable. My real bra will fit normal and then when the wave of tightness hits - it feels like my breasts are going to bust out of the bra. I worried that it was lymphedema of the breast but my breast surgeon told me that it was next to impossible because I only had a sentinel node removed. I asked about physical therapy and both breast and plastic surgeon said I did not need it because of the prepectoral reconstruction. I feel like no one understands what I am feeling. I have taught myself how to calm it down with some stretches and lymphatic massage once it hits. That seems to help. I wish there were more resources out there to help us with this issue. I also feel this tightness first thing in the morning when I get out of bed.

Dear Lauren, we're very sorry to hear that you're experiencing this. We recommend that you continue to seek out a physical therapist who may be able to help you with these problems. You may also find it beneficial to speak with other women who have gone through this. Our online support group, Connections, helps cancer patients, survivors, and caregivers to connect and support each other by offering advice and encouragement. You can learn more by going to… It is open to anyone and not just people who were treated at MSK. Thank you for your comment, and best wishes to you.

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