A multidisciplinary, comprehensive clinic,
geared to treat, research, and prevent
the array of symptoms known as
"Post-Mastectomy Pain Syndrome"
Women suffering from Post-Mastectomy Pain Syndrome may have elements of reduced mobility, flexibility, and strength, that may contribute to the cycle of pain.
Focused physical therapy may reverse these effects, and may help reduce scar tissue formation around injured nerves, that may also play a role in the syndrome.
Pre-operative physical therapy is recommended to optimize the body's condition prior to the stressors of surgery. It undoubtedly is an important part of any surgical recovery. Aerobic activity, stretching, and strengthening help decrease recovery time, improve functional ability, and may help in reducing the incidence of chronic pain after surgery.
For women recovering from breast cancer, physical therapy is prescribed post-surgery for several reasons: soft tissue mobility (muscle, fascia, tendons, ligaments), scar tissue minimization and release, and muscle strengthening.
Therapy is administered by a physical therapist dedicated to breast cancer treatment, as part of the multi-specialty team.
A multimodal regimen is instituted to reduce postoperative pain. The regimen is designed to reduce the amount of narcotic medications prescribed, thus reducing the risk of opioid dependance. Low doses of drugs, that are synergistic and safe to combine, are given prior to surgery. They are also used during, and immediately after surgery.
This is a well proven method to decrease postoperative pain and side effects. Prevention of significant postoperative pain may reduce the likelihood of developing chronic pain.
Some of the medications used are: acetaminophen, non-steroidal anti inflammatory drugs, neuromodulators, low dose opioids, and cannabinoids.
Patients that have chronic pain following mastectomy, are treated by a breast pain specialist that can prescribe a tailored regimen, as part of the multidisciplinary approach.
If oral pain medications fail to fully address chronic post mastectomy pain issues, patients may be treated with local or regional anesthetic interventions.
These modalities are best used if specific areas can be pinpointed upon examination, or if injured nerves can be identified with the use of medical imaging (EMG, ultrasound, CT, or MRI.)
Other causes of chronic pain should be considered and managed. Treatments that can be employed include: local anesthetic injections, steroid injections, regional nerve blocks, and implantable nerve stimulators.
An expert in interventional pain management works conjunction with the comprehensive treatment group, to apply the appropriate care as indicated.
After nonsurgical modalities to treat chronic post-mastectomy pain have been exhausted, a surgical approach is considered.
If trigger points are identified on physical exam that have not responded to less invasive treatment, the assumption is that a trapped nerve (or multiple nerves) are 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 ways: "replantation" into surrounding body tissue, "capping" using a special nerve cap, and "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.
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Meet with our team remotely via telemedicine
Follow up appointments and treatments with members of the teams, as needed
We will contact you to set up a virtual meeting
Based on the telemedicine meetingan in-person consultation with the appropriate team member will be scheduled
How this works
Breast cancer affects one in eight women across the United States. In 2020, an estimated 276,480 new cases of invasive breast cancer are expected to be diagnosed, along with 48,530 new cases of non-invasive (in situ) breast cancer. As of January 2020, there are more than 3.5 million women with a history of breast cancer in the U.S. This includes women currently being treated and women who have finished treatment. Mastectomy is part of the treatment in up to 40% of cases. Of that, up to 30% will develop Post-Mastectomy Pain Syndrome (PMPS.)
We believe that a major cause of chronic post-mastectomy pain is related to surgical injury of sensory nerves of the breast and chest area. This occurs as part of standard mastectomy today, and is considered acceptable. Our experience has shown us that appropriate handling of the nerves during the mastectomy may avoid the problem altogether. Management of the repercussions of nerve damage in the chest, breast, and axillary (armpit) area is difficult. There are specialists that focus on management of nerve damage elsewhere in the body (arms, legs, head.) However, in the breast this is an under-addressed area in terms of diagnosis, treatment, and prevention.
Breast Relief is a unique clinical and research initiative, geared towards addressing and preventing PMPS. By diagnosing patients, systematically treating them, and educating healthcare and patient communities, we ultimately aim to shift paradigms in surgical treatment of breast cancer.
Diana Tjaden, PT, DPT
Leaders in post-mastectomy physical therapy, regional anesthesia, breast and nerve reconstruction
Diana developed Full Circle Breast Cancer Recovery Program, which has its home in Garden City, New York. This comprehensive, individualized program is geared towards every phase of breast cancer recovery. Among its goals are educating women with breast cancer on ways to regain control over their lives, and providing them the tools they need to return to their prior level of function, and reach new fitness goals.
Jonathan Bank, MD, FACS
David Rosenblum, MD
Creator of Breast Relief, Dr. Bank is a board-certified plastic surgeon with specialty training in microsurgery. Stemming from his interests in autologous breast reconstruction and sensory restoration of the reconstructed breast, this endeavor aims to shift paradigms in surgical treatment of breast cancer. He performs all aspects of facial, breast, and body cosmetic surgery in New York.
Dr. Rosenblum is a leader in the fields of interventional pain medicine and regional anesthesiology. His particular interests include regional anesthesia and ultrasound-guided nerve blocks. He has developed numerous protocols and policies to ensure the safe proliferation of anesthesia and pain management. He currently represents the Maimonides department of anesthesia in the development of programs for ensuring adequate pain control of obstetric, orthopedic, and cancer.