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1、TREATINGPAINAFTERSURGERYAndreaV.Barrio,MD,FACSAttendingBreastSurgeonAssociateProgramDirector,BreastFellowshipProgramTheBrynMawrHospitalINTRODUCTIONBreastcancermostcommoncanceramongwomenACSestimates232,340newcasesin20131Secondmostcommoncausedeath39,620deathsin20
2、131Trendsin5Yr.survivalBREAST1975-19771984-19861996-2004CANCER75%79%89%1www.cancer.orgPainaftersurgerySCOPEOFTHEPROBLEMEstimated2.9millionbreastcancersurvivors2012Persistentpostsurgicalpaindemonstratedin25-50%ofpatientsundergoingbreastcancersurgery1Painaftersur
3、gery:Introduction1KehletH,Lancet,2006OVERVIEWAnatomyPresentationofbreastcancerCommonsurgicalproceduresforbreastcancerCausesofacutepost-surgicalpainCausesofpost-surgicalsensorydisturbancesLymphedemaTreatmentPainaftersurgeryBREASTANDAXILLARYANATOMYBREASTANATOMYFe
4、malebreastLobules(milk-producingglands)Ducts(tubescarrymilkfromlobulestonipple)Stroma(fattytissueandconnectivetissuesurroundingductsandlobules)PainaftersurgeryTHELYMPHATICSYSTEMPartofbody’sdefensesystemMostlymphaticvesselsinthebreastconnecttolymphnodesunderthea
5、rm(axillarynodes)Someconnecttolymphnodesinsidethechest(internalmammarynodes)andsometothoseabovethecollarbone(supraclavicularnodes)PainaftersurgeryPainaftersurgery:AnatomyPainaftersurgery:AnatomyHOWDOBREASTCANCERSPRESENT?BREASTCANCERPRESENTATIONImagingabnormalit
6、yMassCalcificationsArchitecturaldistortionPalpablelumpSkinchangesChangesinnippleRashNippledischargePainaftersurgeryBREASTCANCERPRESENTATIONImagingabnormalityMassCalcificationsArchitecturaldistortionPalpablelumpSkinchangesChangesinnippleRashNippledischargePainaf
7、tersurgeryBREASTCANCERPRESENTATIONImagingabnormalityMassCalcificationsArchitecturaldistortionPalpablelumpSkinchangesChangesinnippleRashNippledischargePainaftersurgeryDiagnosisusuallymadewithimage-guidedbiopsyIMAGE-GUIDEDBREASTBIOPSYMinimallyinvasivebiopsystanda
8、rdofcareforinitialdiagnosisofimagingabnormalitiesHematomaafterbiopsycanoftencausesignificantdiscomfort/painPainaftersurgeryCANIDECREASEMYCHANCESOFHAVINGAPOST-BIOPSYHEMATOMA?
