Phantom breast syndrome, how and why it appears

Breast cancer is the tumor that most affects the female population, with 35,000 new diagnoses annually, almost 29% of the total cancers detected in women are breast, according to SEOM data. One of the most used treatment options is surgery, and when this cannot be conservative, a mastectomy is used, an operation that more than 21,000 women undergo each year in our country, and in which one or both are removed. patient’s breasts, which entails various physical and psychological effects.

1 . What is phantom breast syndrome?

More and more women are surviving breast cancer, but up to 90% experience unexpected long-term consequences as a result of treatment. One of them is ‘phantom breast syndrome’, a term used to describe a series of symptoms and sensations, in some cases painful, that some women experience after undergoing a mastectomy. The intensity of symptoms can vary widely from person to person, but they often include manifestations in the area where the breasts used to be, such as itching, tingling, pain or pressure, or the feeling that you still have a breast despite have been removed. These effects can extend to other areas such as the armpit, surgical scar, and inner arm, usually with persistent pain that continues beyond the normal expected time for post-surgical discomfort.

Phantom breast pain and sensations usually begin within the first year after a mastectomy and often become less noticeable two years after surgery. This pain and sensory dysfunction can also contribute to secondary complications, such as reduced range of motion in the arm.

2 . Why phantom sinus syndrome appears

The name ‘phantom breast syndrome’ is therefore similar to the term ‘phantom limb’, which is used to describe the sensation that an amputated limb is still present, and develops for the same reasons: the brain continues to send signals to the nerves in the breast area that were cut during surgery, even though the breast is no longer there. Although not an official medical diagnosis, this experience can be very real for some people and can affect their quality of life and emotional well-being.

It is important to note that not all women who undergo a mastectomy experience phantom breast syndrome, but you are more likely to have this unpleasant sensation in the operated area if you had breast pain before undergoing a mastectomy, a factor that It can double the probability of suffering from this syndrome. Dr. Helena Huertas, oncologist at Onelife Center, points out that “after mastectomy, around 30% of women may experience sensations in the area of ​​the chest where the breast is no longer present, and it is estimated that it reaches be painful in approximately 34% of cases.” A study carried out among 50 mastectomized women at the General University Hospital of Castellón concluded that 76% of the women surveyed presented some type of strange or painful sensation in the area of ​​the breast scar, of which 65.8% presented unusual sensations. painful and 34.2% painful. Phantom breast syndrome appeared in 38% of the women questioned, and in many of the cases (31.6%) of those who responded affirmatively it was expressed in the form of itching in the absent nipple.

On the other hand, it has also been documented that women over 66 years of age are less likely to develop this syndrome compared to those under 51 years of age, who have a 3.9 times higher risk, as well as those with higher education ( more than 8 years of studies).

In any case, there is no single known cause for this phenomenon. It is believed that several reasons may contribute to phantom breast sensations, including:

• Damage to the intercostal nerves: This syndrome may result from damage to neuromas (lumps of nervous tissue that can form after a nerve is damaged) that arise as a result of surgery (breast removal or reconstruction) or from radiation, or in which scar tissue that develops gradually compresses a nerve. Damage to the intercostobrachial nerve is very common during mastectomy (estimated to affect 20-50% of patients) and, therefore, may be the most common cause of phantom sinus.

• Neuroplasticity: The brain is highly adaptable and can reorganize itself in response to changes in the body. After mastectomy, areas of the brain that used to be related to breast sensations can still send signals, resulting in the perception of sensations in the removed breast area.

• Remnant nerves: Although breast tissue is removed, some nerves in the region may remain intact. These nerves, along with neuromas that may form, may continue to transmit signals to the brain, which may contribute to the sensation of phantom breast.

• Emotional factors: Emotions and stress can influence the perception of pain and sensations. Thus, people who have experienced a mastectomy may feel intense emotions related to the loss of their breast, which may influence their perception of sensations in the breast area.

• Scarring and connective tissue: Scarring and changes in connective tissue after surgery may contribute to unusual sensations in the region of the removed breast.

3 . Solutions to phantom breast syndrome

It must be made clear that this is not an imaginary sensation, but a physical problem, so, in fact, “when the removed breast hurts, it may be necessary to use drugs such as anticonvulsants and analgesics for neuropathic pain, that is, That is, the one that finds its cause in the nervous system,” says Dr. Helena Huertas. It may also be necessary to “prescribe antidepressants, since the great emotional impact that a mastectomy causes for many women makes this pain intensify.”

Some people may find relief from this syndrome through pain management techniques, physical therapy, or occupational therapy. It is also essential that people who have undergone a mastectomy have access to adequate emotional support to address any concerns or distress related to breast loss and residual sensations. In many cases, health professionals can provide guidance and support to people experiencing this syndrome.

There are several strategies and approaches that can help relieve symptoms and improve the quality of life for people experiencing it:

1. Talk to a healthcare professional: The first thing you should do if you experience phantom sinus syndrome is to talk to your doctor or a healthcare professional. They can evaluate your symptoms, offer guidance, and provide recommendations specific to your case.

2. Pain management: If you experience pain or discomfort in the removed breast area, your doctor may prescribe pain medications such as pain relievers and nerve stabilizers, or suggest pain relief methods, such as capsaicin patches or CBD oil.

3. Manual physical therapy and occupational therapy: A physical therapist or occupational therapist can work with you to improve function and comfort in the removed breast area. This may include exercises to strengthen the surrounding muscles and massage techniques, “being of special interest for the recovery of shoulder and arm mobility, which can help reduce pain. Furthermore, in more severe cases of pain, nerve blocks or local anesthetic injections may be considered, carried out by specialized pain units, in order to seek local relief” recommends Dr. Helena Huertas. Physiotherapist Gabriela Araya concluded after a review of studies that “manual techniques such as release of trigger points, therapeutic massage and neurodynamics are recommended to treat myofascial and nervous tissue affected by surgery; as well as the use of neuromuscular taping to improve the affected mechanosensitivity in women with this syndrome.”

4. Alternative physiotherapy techniques: Gabriela Araya also recommends other options such as “TENS (transcutaneous electrical stimulation), superficial thermotherapy and cryotherapy as physiotherapy techniques to treat pain.” TENS is a technique that consists of a portable generator of electrical currents that cross the intact surface of the skin and activate nerve fibers, producing an analgesic effect. Regarding cryotherapy, he recommends “applying a massage for 10 minutes in a circular manner with an ice cube, or Ice-Rolling, directly on trigger points or in an area no larger than 15cm.²”.

5. Psychological therapy: Patients undergoing breast cancer surgery with chronic pain have greater psychological stress and psychiatric morbidity than the general population. A therapist or counselor who specializes in the emotional health of people who have had a mastectomy can help you deal with the emotions and stress related to breast loss and residual sensations.

6. Relaxation and mindfulness techniques: Practicing relaxation techniques, such as meditation and deep breathing, can help reduce anxiety and discomfort associated with phantom sinus syndrome.

7. Breast Prostheses: Many women who have had a mastectomy choose to use breast prostheses to restore the appearance and symmetry of the body. You can talk to a breast prosthesis specialist to find the option that best suits your needs.

8. Support Groups: Joining a support group of people who have been through similar experiences can be comforting and provide advice and emotional support.

9. Education and understanding: Learning more about phantom sinus syndrome and its possible causes can help you better manage the symptoms and reduce associated anxiety.