Post-mastectomy pain syndrome: causes, symptoms, and treatments
Learn about post-mastectomy pain, including its causes, symptoms, how long it may last, and exercises physical therapists recommend.
Table of Contents
Most people expect some pain or numbness right after breast cancer surgery. But it’s also possible for sensations to linger or appear after your initial healing period. If you feel pain, tingling, or tightness around your chest wall, arm, or side months after surgery, it could be post-mastectomy pain syndrome (PMPS).
Post-mastectomy pain syndrome refers to ongoing discomfort or pain after surgery or treatment for breast cancer. It can show up in different ways, including burning or stabbing sensations, numbness, or pain. Post-mastectomy pain syndrome may sometimes make it difficult to move or do daily activities.
“It’s very common to feel unexpected sensations months after breast cancer surgery,” says Brittney Sellers, a physical therapist at Hinge Health. It’s often a sign of your body’s nerves adjusting, she explains. “With movement, support, and patience, those sensations can improve and you can regain confidence in your body.”
Read on to learn about post-mastectomy pain syndrome, and its causes, symptoms, and treatments. Plus, get exercises recommended by Hinge Health physical therapists to help relieve post-mastectomy pain syndrome discomfort.
Reviewed by our clinical and medical experts
Brittney Sellers, PT, DPT
Dr. Sellers is a Hinge Health physical therapist specializing in pelvic health, breast cancer recovery, and menopause care. She’s a board-certified women's health specialist and women's health coach. Read More
Christynne Helfrich, PT, DPT
Dr. Helfrich is a Hinge Health physical therapist with nearly 15 years of experience. She is an orthopedic certified specialist and is certified in myofascial trigger point therapy. Read More
Richard Keyme, MD
Dr. Keyme is board-certified in Physical Medicine & Rehabilitation, Brain Injury Medicine, and fellowship-trained in Interventional Pain & Spine. He is a Senior Expert Physician at Hinge Health. Read More
What is post-mastectomy pain syndrome?
Post-mastectomy pain syndrome is when pain lasts for more than three months after breast cancer treatments. The syndrome may include nerve-related symptoms such as burning, stabbing, or tingling sensations. It can sometimes making daily movement and activities difficult. This condition affects about 20-68% of women who have had a mastectomy.
Although called “post-mastectomy” pain, this syndrome is typically used to describe pain that develops after many breast surgeries and treatments, including procedures like lumpectomy or reconstruction, as well as therapies such as chemotherapy or radiation. More recent terms like post-breast surgery pain syndrome (PBSPS) are sometimes used to recognize the wider group affected by ongoing pain after various breast procedures.
Causes of post-mastectomy pain syndrome
Post-mastectomy pain syndrome can result from factors before, during, and after surgery, such as nerve injury, neuroma formation, scarring, lymphedema, treatment type, individual risk factors, and surgical techniques. Here are the most common causes and risk factors for post-mastectomy pain syndrome:
Surgical positioning and intraoperative nerve stress. Your position during surgery can sometimes affect how the nerves in that area feel afterward, leading to sensations like tingling, numbness, or discomfort, which usually improve over time as your body recovers. While your surgical team determines the best position for your safety and the procedure itself, you can share any concerns or history of nerve issues with them beforehand. This lets your team take extra precautions or make small adjustments when possible to help minimize nerve-related symptoms after surgery.
Nerves affected during surgery. Surgeries for breast cancer, such as mastectomy, lumpectomy, or lymph node removal, can sometimes affect the nerves in the chest, underarm, or upper arm — especially the intercostobrachial nerve (ICBN). This can lead to sensations like numbness, tingling, or sensitivity in the upper arm or chest wall. Nerve changes are a big piece of the puzzle with post-mastectomy pain syndrome, says Dr. Sellers. “Even if your skin or scars seem to be healing well, those deeper nerve connections may still be in repair mode, which can lead to sensations like tingling, burning, or changes in the way the skin feels,” she explains. Chemotherapy and radiation therapy can also influence the way your nerves and tissues heal and make nerves more sensitive.
Neuroma formation. When nerves are affected during surgery, it can lead to the growth of a neuroma. This is a small, sensitive area that may cause ongoing sensations.
Scarring, fibrosis, and tissue changes. After surgery, it’s common for scar tissue to develop in the chest or shoulder area as part of the healing process. A similar type of scarring called fibrosis can also develop deep inside the body, which can extend beyond the incision area. These can cause the chest, shoulder, and arm areas to feel tighter or less flexible. Treatments like radiation can also add to feelings of stiffness or discomfort.
Lymphedema. Swelling due to lymph node removal or radiation may lead to sensations of heaviness, tightness, and aching, especially in the arm or chest on the side of surgery.
Type of cancer treatment. Procedures that involve more tissue removal — such as modified radical mastectomy, full axillary lymph node dissection, or removing several lymph nodes — as well as treatments like radiation or certain chemotherapy medicines, may be linked with an increased chance of ongoing discomfort or other symptoms after surgery.
Psychological and biological factors. Factors such as younger age, previous pain conditions, mood and sleep challenges, or a higher body mass index (BMI) have all been linked with a greater likelihood of experiencing ongoing symptoms. Some research suggests that having higher levels of pain or anxiety around the time of surgery can make your body more sensitive to pain signals afterward.
Facility and provider factors. Some research suggests that medical centers that perform these procedures frequently are more likely to use approaches that improve outcomes.
Symptoms of post-mastectomy pain syndrome
Post-mastectomy pain syndrome can cause symptoms such as nerve pain, tingling or numbness, a feeling of tightness, pain from light touch, reduced mobility, swelling in the arm or chest, and changes in mood or daily functioning.
“Living with nerve pain after surgery isn’t just about the discomfort,” says Dr. Sellers. It can affect everyday things you might not expect, like using your arm to reach, getting dressed, or even hugging someone, she explains.
Although each person’s experience can be different, common symptoms of post-mastectomy pain syndrome include:
Painful sensations. Many people describe a sharp, electric, or burning quality to the pain that can be persistent or intermittent.
Tingling, numbness, or pins-and-needles sensations. You might notice these sensations around your incision or under your armpit.
Tightness or pulling sensations. A feeling of restriction is common, particularly in the chest wall or arm.
Heightened sensitivity. Light touch, pressure, or clothing can feel uncomfortable.
Changes in shoulder or arm strength and movement. Discomfort, swelling, or scar tissue can make it harder to move your arm or shoulder.
Lymphedema. Some people experience swelling in the arm or chest after surgery. This can sometimes make the area feel achy or heavy, and may affect how easily you can move.
Daily and emotional impacts. Post-mastectomy pain syndrome can sometimes contribute to changes in mood, sleep, or energy, and may make certain activities feel more challenging.
Who gets post-mastectomy pain syndrome?
Post-mastectomy pain syndrome can affect anyone after breast surgery, but risk is higher for women, younger people, those with chronic pain, more extensive treatments, intense postoperative pain, and people with factors like psychological stress, high BMI, and sleep issues. Here’s more on factors that can contribute to post-mastectomy pain syndrome:
Gender. Post-mastectomy pain syndrome most often affects women treated for breast cancer. But PMPS can affect both women and men after any kind of breast or chest surgery — not just mastectomy for cancer.
Age. People under the age of 50, especially those under 40, may experience post-mastectomy pain syndrome more often. This could be related to differences in treatments or how younger bodies respond to nerve changes.
History of persistent pain. People with ongoing pain, such as headaches or discomfort near the surgical area, before surgery may notice that pain continues or becomes more noticeable after their procedure. This can happen because the nervous system sometimes becomes more sensitive over time. This is known as “central sensitization.”
Type of surgery and treatment. Certain treatments such as radical or modified mastectomy, removal of many lymph nodes, radiation, or some chemotherapy medicines may be linked to more ongoing symptoms after surgery.
Tumor staging. Advanced stage cancer is linked to a higher chance of developing post-mastectomy pain syndrome.
Pain control after surgery. Having more intense pain soon after surgery can be linked with a greater chance of experiencing ongoing discomfort later on.
Other risk factors. Psychological stress, depression, smoking, high BMI, and sleep issues can also contribute, as can treatment at hospitals or clinics with lower surgical volumes.
Breast reconstruction and ongoing pain
It’s understandable to wonder whether breast reconstruction increases the risk of ongoing pain after breast surgery. While more research is still needed, studies suggest that breast reconstruction does not significantly increase the risk of developing post-mastectomy pain syndrome or other long-term pain conditions. Each individual’s experience is unique, but reconstruction itself hasn’t been shown to be a major driver of chronic pain.
“If you chose to have breast reconstruction and are now dealing with pain, please don’t blame yourself,” says Dr. Sellers. There are so many factors that contribute to post-mastectomy pain syndrome, and your decision was made with the best information and intentions at the time. “And no matter where you are in your recovery, there are steps you can take to feel better.”
How long does pain typically last after a mastectomy?
Post-mastectomy pain syndrome refers to pain that lasts for more than three months after breast surgery. Some providers wait until the pain lasts six months or more — and is present much of the time — to diagnose post-mastectomy pain syndrome, but earlier management can lead to better outcomes.
For some people, symptoms of post-mastectomy pain syndrome can last for several years, although experiences vary widely. Symptoms may come and go or change over time. Not everyone will have prolonged pain, and many people find that symptoms gradually improve. Knowing that recovery can look different for everyone may help you work with your healthcare team to find effective ways to manage and support your healing.
Treatments for post-mastectomy pain syndrome
Treatment for post-mastectomy pain syndrome often includes physical therapy and exercise, medications for nerve pain, pain-relieving procedures, interventional treatments, surgical options, psychological support, and complementary therapies. Here’s more about treatments for post-mastectomy pain syndrome:
Try physical therapy and targeted exercises. Targeted exercises improve flexibility and help restore function and comfort to the shoulder, chest, and arm. Stretching and strengthening exercises can reduce pain and improve scar tightness. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.
Stay active. Targeted post-mastectomy exercises are designed to help with recovery, but any type of movement — like walking, stretching, or even household chores — can improve functional ability and reduce pain. Talk to your doctor before returning to activity after surgery or before starting any new exercise program.
Over-the-counter (OTC) medication. It’s common to use prescription medications to manage pain immediately after your surgery. As your recovery progresses, over-the-counter pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have post-mastectomy pain. Other options are topical NSAIDs and pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are safe to take.
Medications for nerve pain. Medication options may include gabapentin, pregabalin, or certain antidepressants like amitriptyline and duloxetine. Topical treatments such as capsaicin cream, lidocaine patches, or other medicines applied to the skin can also be considered for some symptoms. These medications are often used to help manage nerve-related discomfort and may improve symptoms for some people. Your provider can help you explore whether any of these options could be a good fit.
Nerve blocks or injections. Procedures such as nerve blocks (like intercostobrachial or serratus plane blocks) and trigger point injections may be recommended as part of your care plan to help manage ongoing discomfort. These approaches can offer relief for several weeks or even months for some people.
TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce pain associated with conditions like post-mastectomy pain syndrome. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable. Check with your doctor before starting TENS, especially if you’ve recently had surgery. For safety and healing, do not apply TENS devices directly across your chest or over/near areas of active cancer. Always follow the device instructions. Your provider can help you decide if TENS is right for you and guide you on the safest way to use it.
Pain relief procedures. In some situations, pain specialists may suggest advanced treatments if other approaches haven’t provided enough relief. This can include pulsed or thermal radiofrequency treatments or minimally invasive nerve stimulation therapies.
Surgical treatments. If pain is traced to a specific area, such as a neuroma or scar tissue, options like targeted nerve surgery, neuroma removal, fat grafting, or scar release may be considered. In some cases, your doctor may suggest nerve stimulation therapies that involve placing small implanted devices — such as peripheral nerve stimulators (PNS) or spinal cord stimulators (SCS) — in the body to help manage pain. These procedures are typically explored when other approaches haven’t brought enough relief.
Psychological support and education. Cognitive behavioral therapy (CBT), mindfulness, pain neuroscience education, and other psychological therapies can help ease symptoms of ongoing pain.
Complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for post-mastectomy pain syndrome relief, such as massage, acupuncture, high-intensity laser therapy, or chiropractic care.
Studies show that multidisciplinary care that incorporates several of the above approaches leads to better outcomes for post-mastectomy pain syndrome than relying on any one intervention alone.
“Post-mastectomy pain syndrome can be complex, and there’s no one-size-fits-all solution,” says Dr. Sellers. Combining physical therapy, education, medication when needed, and care for your mental and emotional wellbeing can all play a role in your recovery, she explains.
Physical therapy for post-mastectomy pain syndrome
Physical therapy is a key treatment for post-mastectomy pain syndrome, focusing on gentle movement, targeted exercises, and stretches to relieve discomfort and support healing after surgery. The goal is to restore range of motion in the shoulder and chest, strengthen muscles that may have weakened during recovery, such as those in your upper back and shoulder, and stretch areas that often become tight, like the chest wall and underarm, says Dr. Sellers. “Targeted exercises and stretches can help reduce pain, improve mobility, and address muscle imbalances that can develop after breast surgery,” she explains.
A physical therapist (PT) can assess your movement and arm function to design a customized program for strengthening, stretching, and managing scar tissue. They can also provide tips to modify everyday activities to make them more comfortable and recommend strategies to reduce pain and improve function. Recommendations may include gentle self-massage to address scar tissue, posture adjustments, and relaxation techniques.
“Movement is powerful medicine after breast surgery,” says Dr. Sellers. You start with what feels comfortable for you and there’s no right or wrong place to begin, she explains. “Even small, gentle exercises done consistently can make a huge difference in regaining comfort and function,” says Dr. Sellers.
Exercises for post-mastectomy pain syndrome
Want expert care? Check if you're covered for our free program →- Standing rotation
- Doorway stretch
- Diaphragmatic breathing
- Shoulder rows
- Chin tucks
- Wall slides
- Upper body nerve glides
These exercises work together to help manage post-mastectomy pain syndrome in several ways. Thoracic mobility rotation can ease upper back stiffness and make twisting and reaching more comfortable. The doorway stretch gently opens the chest and helps promote healthy nerve movement. Diaphragmatic breathing supports relaxation and reduces muscle tension. Resisted rows strengthen the upper back to improve posture and arm mobility. Chin tucks help realign your neck and upper spine, supporting better posture after surgery. Wall slides encourage gentle shoulder movement to reduce stiffness, and upper body nerve glides, when appropriate, can ease tingling or pinching sensations by encouraging freer nerve motion.
Practicing these exercises regularly can help manage post-mastectomy pain syndrome by increasing flexibility, improving strength and posture, and supporting daily comfort and function. This added movement and muscle support can help you regain confidence and make daily activities feel more comfortable and manageable.
Note: These exercises are intended as general examples and may not be appropriate for everyone. Talk to your rehabilitation provider before trying any of these movements to make sure they are safe and suitable for your specific stage of recovery. Your rehab provider can guide you in choosing exercises that are right for your unique situation and help you progress safely.
The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.
Physical therapy (PT) is for more than just recovering from surgery or injury. It’s one of the top treatments for joint and muscle pain. It helps build strength, improve mobility, and reduce pain. And it doesn't always need to be in person.
Hinge Health members can conveniently access customized plans or chat with their care team at home or on the go — and experience an average 68% reduction in pain* within the first 12 weeks of their program. Learn more*.
When to see a doctor
Many people find that symptoms of post-mastectomy pain syndrome improve with time, movement, and supportive treatments, but everyone’s experience is different. If your pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It’s also a good idea to get care if you have:
Significant swelling, redness, or warmth near your surgical site
Fever, chills, or drainage from the incision
Persistent numbness or weakness in your arm or hand
Any concerns about new or changing symptoms after breast surgery
PT tip: It’s never too soon (or too late)
Seeing a physical therapist soon after surgery can make a big difference, says Dr. Sellers. “But even if you’re long past your initial recovery, it’s never too late.” You can still reduce symptoms and make meaningful improvements by working with a physical therapist, no matter where you are in your healing process, she explains.
How Hinge Health can help you
If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.
The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.
Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.
See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.
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