The question below is answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction.

I had a Phase 1 SIEA flap reconstruction in February 2010, and a Phase 2 in November 2010. Abdominal and drain scars were revised in November 2010, but I’m still having severe pain, tightness, and discomfort, including bad scarring on part of the big abdominal incision and on both abdominal drain sites. I’m assuming that I need another surgery (I’m seeing my plastic surgeon soon). Is it correct to assume there’s a chance any new revisions might not work? And are there any techniques that could alleviate some of the abdominal tightness?

I’m sorry that you are experiencing a rare, but, unfortunately, persistently recurring, complication – not specifically of breast reconstruction surgery, but of any surgery.

Any time skin or other body structures are cut, myriad nerves, a few named, most unnamed, are unavoidably divided, or at least damaged. Most of the divided or damaged nerves “wither away,” and cause no problem. A very few of the damaged nerves stay “irritated,” and some of the divided nerves form “neuromas,” or very tender balls of nerve tissue. These account for much of the chronic pain, which some people experience following surgery. Why this occurs when it does, and how to predict or prevent it, are questions all surgeons would love to know the answer to. It is not preventable – the best a surgeon can do is warn patients that it could happen.

As a practical matter, re-operating for painful scars may not be very productive. When our patients have chronically painful surgical sites, we refer them to pain management specialists for treatment. Usually this involves injections of local anesthetics, steroids, or other agents. We have generally been pleased with the results we have seen from this.

If there are other reasons to revise your surgical site, it is not completely unreasonable to think that more surgery may favorably affect the pain, and we wish you the best of luck in that scenario.

–Dr. Richard M. Kline, Jr.

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