Developing rib pain years after a mastectomy for breast cancer can be confusing and distressing. Although you should be sure to let your oncologist know about this symptom, take comfort in the fact that breast cancer recurrence is unlikely after undergoing a mastectomy. Your doctor can help you determine the cause 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, and it wraps around to my back. If I push lightly on the bone down from my armpit, it’s sore. Has anyone had this problem? 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 had 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 worrying symptom.

Reasons Rib Pain Occurs After a Mastectomy

Rib pain that persists years after a mastectomy is often due to neuropathy — or nerve pain — that is believed to be caused by nerve damage. The damage may occur during breast cancer surgery or when scar tissue forms around nerves. This condition is known as post-mastectomy pain syndrome (PMPS) and is a type of chronic (long-term) neuropathic pain.

Pain may be felt in the chest wall, shoulder, arm, or armpit. The chest wall is the structure that protects the organs in the torso and includes the ribs, spine, and sternum. Chest wall pain may be experienced as back pain.

Almost 30 percent of people who have mastectomies experience PMPS. The condition 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 PMPS include age, tumor stage, a history of chronic pain, total mastectomy, and axillary lymph node dissection (surgery to remove lymph nodes from the armpit). Although PMPS can occur or persist years after a mastectomy, the condition is defined as pain that continues more than three months after breast surgery.

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

Other 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 (breastbone) — may be a result of injury, illness, or intense coughing.

Breast Cancer Recurrence and Serious Complications With Rib Pain

Breast cancer recurrence after mastectomy occurs in about 6 percent of cases within five years when the cancer is not found in the lymph nodes. If the axillary lymph nodes are also cancerous and radiation therapy is given, there is also a 6 percent risk of cancer recurrence in five years. If radiation therapy is not used with axillary lymph node cancer, the risk increases to 25 percent.

In rare cases, 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 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 tips may help you manage your pain and improve your quality of life.

Self-Advocacy

If you are 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 are 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 the appointment to take notes during a consultation with your doctor.

Physical Therapy

Physical therapy 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 team member shared.

Another member wote, “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. Although research is limited, there is some evidence that this technique helps people under the age of 60.

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 in March. 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 that is associated with post-mastectomy pain syndrome. MBCT combines cognitive therapy (a type of psychotherapy, or talk therapy) with mindfulness training (a type of meditation that helps you recognize and change negative thought patterns). MBCT encourages positive thinking and proactive actions to enhance a sense of physical and psychological well-being.

Medication

Different types of medication are used to treat PMPS and have been shown to be effective. These medications used 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

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 study showed that the benefits of laser treatment were still in effect three months after treatment.

Surgical Treatment Options

In severe cases of post-mastectomy 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 remove 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 health care team can help you find the best approach to managing this symptom and improving your quality of life.

Find Your Team

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 64,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Have you had rib pain years after your mastectomy? What helped relieve the pain? Share your experience in the comments below, or start a conversation by posting on your Activities page.