Complex regional pain syndrome after breast implant exchange: a case report

Complex regional pain syndrome (CRPS) is a regional, neuropathic pain disorder, with disproportionate symptoms, that does not respect dermatomes or nerve distribution. A 28-year-old female patient with personal history of two breast augmentation surgeries consulted for breast reduction after dissatisfaction with the size and form of her breasts. Breast reduction was undertaken with prosthesis exchange. During the first 10 days, she presented swelling, hyperesthesia, and burning pain mainly around her left breast. An ultrasound showed seroma collection which was drained in two occasions. She was referred to physical therapy to desensitize and initiate additional treatment for symptoms. Three weeks after surgery, bilateral pain persisted, as well as hyperesthesia, edema, and local hyperthermia; thus, referral to an anesthesiologist specialized in pain management with a CRPS type II diagnosis was undertaken which confirmed the diagnosis and additional analgesics were initiated. A week into treatment, she referred decreased signs and symptoms in her breasts. During the second month, symptoms decreased and medication was gradually lowered. At the end of the third month, medication was suspended and she began her normal activities with no symptoms. This case report highlights the importance of clinical suspicion of CRPS. Signs and symptoms should be interpreted in a timely fashion to allow a prompt treatment and speedy recovery. Level of evidence: Level V, risk study.