• Andrew A Gassman, Alfred P Yoon, Justin B Maxhimer, Ivan Sanchez, Harleen Sethi, Kevin W Cheng, Charles Y Tseng, Jaco H Festekjian, Andrew L Da Lio, and Chris A Crisera.
• Los Angeles, Calif. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine.
• Plast. Reconstr. Surg. 2015 Feb 1;135(2):356-67.

BackgroundWomen who undergo mastectomy and breast reconstruction are shown to express more pain than those who undergo mastectomy alone. The authors evaluated postoperative pain outcomes following breast reconstruction.MethodsPatients undergoing primary implant-based (n = 1038) or flap-based (n = 837) reconstructions from 2004 to 2012 at the University of California, Los Angeles, were evaluated. Postoperative pain was measured using the visual analogue scale, total narcotic use, and number of patient-controlled analgesia attempts. Narcotic dosage was standardized to morphine equivalents per kilogram. The authors modeled postoperative narcotic use, patient-controlled analgesia attempts, and visual analogue scale scores over time using spline graphs for comparison between the two reconstruction methods.ResultsBoth total narcotic use and patient-controlled analgesia attempts were higher in the implant-based group throughout the immediate postoperative period. Implant-based reconstruction patients had significantly higher visual analogue scale scores (p < 0.0001) and total narcotic use (p < 0.0001) through postoperative day 3 compared with autologous tissue-based reconstruction patients. When controlling for reconstruction method, bilateral procedures were more painful (visual analogue scale score and patient-controlled analgesia attempts, both p < 0.001). When controlling for laterality, unilateral implant-based and autologous reconstructions had comparable visual analogue scale scores (p = 0.38) and patient-controlled analgesia attempts. However, unilateral implant-based procedures required more narcotic use than unilateral autologous tissue-based procedures (p = 0.0012).ConclusionAlthough commonly perceived as a less distressing operation, implant-based breast reconstruction may be more painful during the immediate postoperative hospitalization than abdominally based free tissue transfer.Clinical Question/Level Of EvidenceTherapeutic, III.

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