203. Prophylactic Intercostal Regenerative Peripheral Nerve Interface for the Prevention of Post Breast Surgery Pain Syndrome in Breast Reconstruction Patients: Pilot Data

PURPOSE: Pain after breast cancer surgery impacts the quality of life of hundreds of thousands of women annually. PBSPS represents chronic, persistent, and sometimes debilitating pain, which greatly impacts quality of life. PBSPS is a diagnosis of chronic pain that may occur after any breast surgery, is at least moderate in severity, is neuropathic in quality, localizes to the breast, chest, or axilla, lasts at least 6 months, and occurs at least 50% of the time. Post-breast surgery pain syndrome (PBSPS) presents in an estimated 13-60% of breast surgery patients. Treatment of neuroma-related PBSPS with regenerative peripheral nerve interfaces (RPNI) has been demonstrated in small case series, however prevention of PBSPS has not. METHODS: Consecutive patients were included who underwent mastectomy and breast reconstruction with intercostal nerve RPNI attempted. RPNI was performed using pectoralis muscle. Diagnosis of PBSPS was made with prospective surveys that allowed identification of pain distribution (e.g., lateral chest wall), and pain qualifiers (e.g., ‘burning’, ‘shooting’) diagnostic of intercostal neuroma formation. Pain severity of at least ‘moderate’ and duration for 6 months were also requirements for PBSPS diagnosis. In patients who did not respond to surveys, the diagnosis of PBSPS was made via retrospective chart review. RESULTS: Twelve patients were included. Median age was 54.7 years. Psychiatric diagnoses were present in eight patients (66.7%). Nineteen skin sparing or total mastectomies were performed. Intercostal nerve surgery was attempted for each breast and was achieved in 17 (89.5%). In two breasts, no intercostal nerve could be identified. Surveys were completed by nine patients (75.0%). Only one unilateral patient developed PBSPS (5.3% of 19 mastectomies, 8.3% of 12 patients). Median follow-up period was 19.0 months. CONCLUSION: We report a low rate of intercostal neuroma-related PBPSPS after treatment with prophylactic intercostal RPNI. PBSPS only developed in one case, lower than the 20-60% rate generally reported in the literature. Our findings suggest that intercostal nerve RPNI may decrease the rate of PBSPS. However, since our sample size is small, further study is required to determine the contribution of neuroma formation to the overall incidence of PBSPS, and the efficacy of RPNI to prevent intercostal neuromas.