Guidelines for Complications of Cancer Treatment Vol VIII Part B

preceded by increased sensory hyperesthesia in 20-30% cases[26,27]. Most of this pain may reduce over a period of timebut a chronic pain still persists for long periods with waxingand waning by external stimulation [28]. This pain isconsiderably significant in younger women, larger tumors,post-radiation and chemotherapy, and in women with poorcoping skills. In fact, antidepressants are sometimes prescribedto manage such neuropathic pain [29].Damage to the lateral thoracic nerve to serratus anterior canresult in permanent deformity of ‘winging of the scapula’ andintractable pain. Care should be taken not to venture too closeto the nerve during axillary dissection especially while usingan electrocautery for dissection. Transection of the medial andlateral pectoral nerves can permanently denervate the pectoralismuscle and cause cosmetic and functional disability.Saving the intercostobrachial nerve was considered as a wayof reducing postoperative neuropathic pain. Unfortunately, thismay not be so as traction on the nerve or partial nerve damage(neuropraxia) eventually results in more intractableneuropathic pain and distress.Proper Incision PlanningProper placement of incisions in both breast conservationsurgery and at the time of mastectomy goes a long way inimproving quality of life of the woman. At the time oflumpectomy, incisions in upper half of the breast should becircumferentially planned while in the lower half, radialincisions are preferred for better cosmetic outcome. In casean excision of skin ellipse is necessary, a radial incision isbetter to avoid nipple deviations and poor cosmetic outcome.An important precaution to be remembered at the time ofmastectomy incisions is to not allow the lateral most point ofincision to cross the anterior axillary line and to use a teardropor pear-shaped incision with point on medial aspect and8