After a mastectomy, some people choose to have breast reconstruction surgery. While the recovery process can bring relief and positive changes, it can also involve various types of pain. Sharp, stabbing pain in the reconstructed breast may be alarming, but it isn’t necessarily a cause for concern.

One member of MyBCTeam explained, “Shooting pain from either breast surgery or radiation is common, and I had it from both treatments on my ‘bad’ days. It sometimes takes months and even years to get past that. Just remember, it is normal as tissue and nerves regenerate. Give it time, talk to your doctors, and take pain meds as needed.”

Being able to tell the difference between common pain and the type of pain that needs medical attention is essential as you recover from surgery. When in doubt, always contact your healthcare provider. Here, we explore possible causes of stabbing pain after reconstruction and what to expect.

Pain After Reconstruction: What’s Usual?

Pain during the first few weeks following reconstruction should be expected. Your surgeon will send you home with instructions on how to keep the pain under control so that you can get the rest you need to recover. A 2018 study found that certain factors were linked to more severe postoperative pain, including:

• Being younger at the time of surgery
• Having both breasts reconstructed
• Having more severe preoperative pain
• Experiencing anxiety and depression

Here are several types of typical side effects you may experience after surgery.

Incisional Pain

Surgical incisions can cause localized sharp pain. People who have had flap reconstruction — when tissue from another part of the body is used to rebuild the breast — or implant-based reconstruction may have pain due to their incisions. This pain usually goes away as the incision site heals.

Inflammation and Swelling

Swelling, itching, and inflammation are common after any surgical procedure, including breast reconstruction. These surgical side effects can contribute to discomfort and aching sensations in the reconstructed breast. Swelling usually peaks within the first few weeks and gradually goes away within eight weeks or so.

Muscle Pain

Flap-based reconstruction may involve the transfer of muscles, fat, and skin from another area of the body, such as the back or abdomen. The muscles in the donor site and the reconstructed breast may experience temporary discomfort and soreness as they adapt to their new positions. Implant-based reconstruction can also lead to muscle pain, especially if the implants are positioned behind the chest wall muscle.

Neurologic Pain

Nerve injuries to the intercostal and pectoral nerves can lead to symptoms like tingling, burning, or shooting pain. This may improve as the nerves regenerate.

Often, nerve pain after surgery is temporary. But, for some people, nerve damage can cause ongoing pain around the surgery site or in the nearby area under the arm. Doctors refer to this as postmastectomy pain syndrome (PMPS). Your doctor can perform a nerve block to determine whether nerve pain is causing your symptoms. Ongoing nerve pain may require surgical treatment, long-term management with medications, or physical therapy.

When Is Post-Reconstruction Pain Cause for Concern?

Severe stabbing pain that doesn’t improve with time or treatment may require medical attention. Here are some possible causes that warrant follow-up with your doctor.

Capsular Contracture

Capsular contracture happens when the scar tissue around a breast implant becomes tight and squeezes, causing pain, hardness, and changes in how the breast looks. If you feel sharp, stabbing pain and notice significant changes in how your reconstructed breast looks or feels, talk to your doctor.

Implant-Related Complications

Sharp, stabbing pain in the reconstructed breast may be a sign of complications, such as implant leakage or rupture. If the pain is accompanied by changes in breast size, shape, or firmness, consult with your medical team as soon as possible.

Infection

Persistent pain that is accompanied by fever, chills, or discharge from the incision site may be caused by an infection. When this occurs, seeking medical attention is crucial to prevent further complications.

Pain should resolve once your body heals, but some MyBCTeam members have noted lingering pain years after treatment. “The scarring from the radiation goes under my armpit also and aches and burns,” said one member. “Basically, I was told that happens sometimes, so I just have to live with that and the very sharp stabbing pains at times in the breast/chest area when I move. Thankfully, that doesn’t happen as often as in the first few years.”

After a mastectomy, between 20 percent and 68 percent of people report dealing with ongoing pain. Finding healthy ways to handle or treat long-lasting pain is important. Practicing healthy ways to handle the pain can help you avoid becoming reliant on opioid medications as well as help you move forward with life after reconstruction surgery.

When Is Stabbing Pain a Medical Emergency?

Sharp, stabbing pain in the chest after breast reconstruction isn’t always a cause for immediate concern, but there are instances when it may be a medical emergency. Because of this, it’s important to be able to recognize the signs and symptoms of potentially life-threatening conditions. In particular, look out for signs of pulmonary embolism (sudden blockage in pulmonary arteries) and heart attack.

Signs of a pulmonary embolism may include:

• Coughing up blood
• Dizziness
• Pain or swelling in the leg
• Rapid heartbeat or palpitations
• Shortness of breath
• Sudden, sharp, stabbing pain in the chest that worsens with deep breaths

Signs of a heart attack may include:

• Cold sweats
• Intense, crushing chest pain (usually in the center or left side)
• A sense of impending doom
• Pain in the arms, jaw, neck, or shoulders
• Nausea
• Shortness of breath
• Dizziness or feeling faint

According to the American Heart Association, women can experience less obvious heart attack symptoms in addition to, or in place of, these symptoms. Other symptoms of a heart attack in women may include:

• Pain or squeezing pressure in the upper part of the back that may feel like a tightening rope
• Sharp, stabbing pain in the neck, arm, shoulder, or back
• Feelings of anxiety
• Upset stomach
• Fatigue or weakness

If you experience sharp, stabbing pain in the chest along with any of these signs, seek immediate medical attention. Infections can also be life-threatening and should be treated right away.

Managing Normal Pain at Home

Your healthcare provider might recommend some of the following pain management strategies. Talk with your doctor at your follow-up appointments to find out if you’re ready for these strategies.

Try Gentle Exercises

Engaging in gentle exercises and stretching as recommended by your healthcare provider can help improve circulation, reduce stiffness, and ease pain over time. It’s important to avoid strenuous activities that may strain the healing tissues. Your doctor may give you a referral for physical therapy so that you can learn safe ways to rebuild your strength after surgery.

Apply Ice Packs

Applying ice packs wrapped in cloth to the affected area can help reduce inflammation and provide temporary pain relief. However, to prevent damage, it’s important not to apply the ice pack directly to the skin. Wrap ice in a towel, and use a timer to avoid overdoing it.

People who have had flap reconstructions using their own tissues may be told to avoid applying ice or heat. This is because of potential risks due to altered feeling in the area and issues with blood flow. Follow your surgeon’s instructions for temperature therapy.

Use Pain Medications as Directed

Follow your healthcare provider’s instructions about pain medication. Take medication only as directed to effectively manage discomfort. For mild pain after surgery, your doctor may recommend over-the-counter pain medications like acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). If nerve pain is suspected, your doctor may prescribe certain non-opioid medications, such as gabapentinoids or serotonin-norepinephrine reuptake inhibitors (SNRIs), or local anesthetics.

If you’re experiencing severe pain, your provider may consider stronger medication like opioids. In general, these are only prescribed if necessary due to the risk of dependence. Some of these pain medications can cause side effects like constipation. Discuss possible side effects and how best to manage them with your doctor.

Practice Relaxation Techniques

Relaxation techniques like deep breathing, meditation, and guided imagery can help manage pain and promote overall well-being. You can also join a local breast cancer support group so you can participate in these activities with others.

Communicate With Your Medical Team

Do your best to maintain open communication with your medical team throughout your recovery process. Take notes on the type of pain you experience, how long it lasts, and when it occurs. Sharp, stabbing pains in the reconstructed breast can be distressing, but your healthcare provider is there to give you support and peace of mind. You can also ask to meet with a mental health professional for help managing the emotional impact of your pain.

Reach out to others for help getting the supplies you need to manage pain at home. If you suspect a more serious issue, don’t hesitate to get a professional opinion.

Join the Conversation

On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.

Did you experience any sharp or stabbing breast pain after breast cancer surgery? Let others know in the comments below.