Developing rib pain years after a mastectomy for breast cancer can be concerning. You should be sure to let your oncologist (cancer specialist) know about this symptom. According to Mayo Clinic, rib pain is most common in women over 40 and often has no known cause. Your doctor can look for potential causes of the pain and find an effective treatment.

Many MyBCTeam members have described rib pain that continues years after their breast cancer treatment (and sometimes after breast reconstruction), and they understandably have concerns. “Has anyone suffered from rib pain since treatment — even years out?” one member asked.

“It’s been three years since my mastectomy, and I have pain under my arm by my ribs. It wraps around to my back. If I push lightly on the bone down from my armpit, it’s sore. I’m a little worried,” another member wrote.

Yet another member shared this experience: “I had a double mastectomy with direct implants almost exactly two years to the day. I had complications with my right breast implant but eventually it finished six months or so later. My question is, does anyone feel pain on your chest wall after having implants? Is it scar tissue? Is it normal, or should I be concerned?”

Read on to learn more about potential causes of rib pain after mastectomy and ways to manage this uncomfortable and sometimes worrying symptom.

Reasons Rib Pain Occurs After a Mastectomy

Rib pain that persists years after a mastectomy is often due neuropathy (nerve damage). The damage may occur during breast cancer surgery or when scar tissue forms around nerves. This condition is known as postmastectomy pain syndrome (PMPS), which can cause long-term neuropathic pain.

You may feel this type of rib pain in the chest wall, shoulder, arm, or armpit, and sometimes even on the back toward the shoulder blade area. The chest wall is the structure that protects the organs in the torso and includes the ribs, spine, and sternum (breastbone).

One study found that almost 30 percent of females with early-stage breast cancer who’d undergone mastectomies experienced PMPS. Less commonly, PMPS can also be caused by lumpectomy or other types of breast-conserving surgery.

Symptoms of PMPS may include:

• Pricking or shooting pain
• Excessive itching
• Numbness or tingling

Risk factors for developing PMPS include age, tumor stage, a history of chronic pain, and total mastectomy. Axillary lymph node dissection (surgery to remove lymph nodes from the armpit) is also a risk factor, though this technique is less commonly used in recent years.

Although PMPS can occur or persist years after a mastectomy, the condition is defined as pain that continues for more than three months after breast surgery.

Left untreated, pain from PMPS can significantly decrease range of motion in the arm and shoulder, which affects quality of life. PMPS is also associated with a higher risk of other breast surgery complications such as muscle weakness, lymphedema (swelling from lymph fluid), anxiety, and depression.

Unrelated Causes of Rib Pain

Rib pain can also be unrelated to breast cancer treatment. For instance, costochondritis — inflammation in the cartilage that connects the ribs and sternum — may be a result of injury, illness, or intense coughing.

Breast Cancer Recurrence and Complications With Rib Pain

If no cancer is found in the lymph nodes during a sentinel lymph node biopsy or an axillary lymph node dissection (two common procedures done during mastectomy), the risk of breast cancer coming back is about 6 percent within five years.

If the axillary lymph nodes do contain cancer cells, the five-year recurrence risk depends on whether radiation therapy is used: It’s about 6 percent with radiation, but it can rise to about 25 percent without radiation.

In rare cases (about 1 percent to 3 percent), rib pain may be due to a rib fracture as a complication of radiation therapy. Radiation therapy can also cause serious complications such as scarring of lung tissue, inflammation in the lungs, skin changes, and heart disease, which may cause pain in the chest wall.

Ways To Manage Rib Pain

A number of treatment options are available for treating rib pain that continues after breast cancer surgery. The following approaches may help you manage your pain and improve your quality of life.

Self-Advocacy

If you’re experiencing rib pain after a mastectomy, it’s essential to talk with your doctor about pain management. It can be helpful to write down how the pain affects your daily life and what exactly you’re doing when you have symptoms.

Bringing written details about your rib pain to an appointment with your doctor will help ensure that you cover everything you want to talk about. You may want to bring a close friend or family member with you to take notes during a consultation with your doctor.

Physical Therapy

Physical therapy (PT) has been shown to help increase range of motion and relieve pain from PMPS in general. “I’m having pain in my rib and some tightness in my right arm/shoulder area. I’m doing exercises to help with the tightness,” a MyBCTeam member said.

A physical therapist can also help you learn to avoid movements that aggravate pain. “I find whenever I use certain muscles, my ribs go into spasm. Even bending over to tie my shoes can make my ribs hurt,” a member shared.

Another member wrote, “I’m four years post left mastectomy, no breast reconstruction. I have lymphedema and go to PT one time a month and wear the compression sleeve two times a day for an hour. I’ve been having rib pain/soreness on both sides.”

Your doctor can provide a referral to a physical therapist to teach you exercises appropriate for your particular condition.

Manual Lymphatic Drainage

Manual lymphatic drainage, also known as lymphatic drainage massage, can sometimes relieve swelling and pain. It may help your lymph nodes get rid of toxins and reduce lymphedema.

Manual lymphatic drainage can be done by a specialist, or you may be able to learn how to administer lymphatic drainage massage on yourself. Be sure to talk to your doctor before trying this technique so that you understand how it should be done.

“I start lymphatic drainage massage soon. Turns out mine is lymphedema in the breast wall,” a MyBCTeam member wrote.

Mindfulness-Based Cognitive Therapy

Research shows that mindfulness-based cognitive therapy (MBCT) can considerably reduce pain intensity associated with postmastectomy pain syndrome. MBCT combines cognitive therapy (a type of psychotherapy) with meditation training. The goal is to help you recognize and change negative thought patterns. MBCT is designed to help people better cope with challenges and improve well-being.

Medication

Different types of medication have proven effective at treating PMPS. These medications include:

• Neuromodulators for treating nerve pain
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs), typically used to treat depression
• Topical medications, such as capsaicin cream or lidocaine patches
• Drugs for neuropathic pain, such as gabapentin and pregabalin

Talk to your doctor about pain medication options and potential side effects to determine if drug therapy may be beneficial for you.

Laser Therapy

Research indicates that high-intensity laser therapy with physical therapy may reduce pain and increase impaired range of motion from PMPS. One small study showed that the benefits of laser treatment were still in effect three months after treatment. Researchers continue to study laser therapy and possible benefits for people with PMPS.

Surgical Treatment Options

In severe cases of postmastectomy pain syndrome, you may want to discuss surgical options to treat persistent rib pain. Advances in surgical approaches to PMPS have helped some people significantly reduce ongoing pain that was not adequately relieved by noninvasive treatments.

Surgical procedures that are sometimes used in the treatment of PMPS include:

• Fat grafting, in which fat from another part of the body is injected into the affected area
• Peripheral nerve surgery to remove pressure on a nerve or repair nerve damage
• Lymphedema surgery to transfer lymph nodes or redirect lymphatic vessels that may be retaining fluid and putting pressure on the chest wall
• Nerve block, which numbs nerve pain and may be done by injection or through a procedure called radiofrequency neurotomy (using heat from radio waves to turn off pain signals)

Rib pain arising years after you’ve had a mastectomy can be upsetting, but you’re not alone. Your healthcare team can help you find the best approach to managing this symptom and improving your quality of life.

Join the Conversation

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

Have you experienced rib pain weeks, months, or years after breast cancer surgery? Let others know in the comments below.