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Breast Flap Neurotization Following Autologous Breast Reconstruction: A Prospective Trial

Nathan, Shelby MD; Mauch, Jaclyn BS; Whitely, Cutler BS; Tecce, Michael G. DO; Rhemtulla, Irfan A. MD, MS; Kozak, Geoffrey MD; Serletti, Joseph M. MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 28
doi: 10.1097/01.GOX.0000584352.23521.39
Breast Abstracts

University of Pennsylvania, Philadelphia, PA

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PURPOSE: Restoration of breast sensation following autologous breast reconstruction (ABR) is integral to the reconstructive paradigm for breast cancer patients. We hypothesize that innervation of reconstructed breast flaps will improve sensation and quality of life (QoL).

MATERIALS/METHODS: Free flap ABR patients with and without nerve allograft neurotization were recruited prospectively. Sensation testing was performed with a Pressure Specified Sensory Device (PSSD) at 12–24 months postoperatively in superior, lateral, medial, and inferior poles on both the mastectomy skin and the flap skin. The BREAST-Q was administered.

RESULTS: Thirty-two women were enrolled with a total of 54 reconstructed breasts (neurotized: n = 22; nonneurotized: n = 32). Average age was 51.9 years (range, 21–77) with a mean body mass index of 28.9 (range, 20–47). Average follow-up was 15.8 months (range, 12–24). Free TRAM flaps were most commonly performed (87%). Mastectomy skin exhibited greater sensation than flap skin (P = 0.20) and 1-point moving tests elicited a greater response than 1-point static (P < 0.00). In all but one area (inferior mastectomy), the neurotized group had more sensation with 1-point static (P = 0.01–0.99) and 1-point moving testing (P = 0.33–0.92). The superior mastectomy pole experienced significantly greater sensation in the neurotized group (P < 0.001). There was no difference in surgical site outcomes between the groups. Nine percentage neurotized versus 5% nonneurotized patients reported “more sensation” after reconstruction (P = 0.32). QoL demonstrated that the neurotized group was more satisfied in 9 of the 11 parameters (P = 0.09–0.89).

CONCLUSION: The return of breast sensation after ABR has become an important topic in reconstructive plastic surgery. Although multiple modalities have been proposed to increase postoperative sensation (eg, nerve conduits, allografts, and autografts), there is a paucity of prospective clinical trials investigating sensory outcomes. This abstract highlights the largest cohort to date, which quantitatively and qualitatively measures the effect of neurotization with nerve allografts on the return of sensation following ABR. To do so, we have directly measured sensation, patient-reported return of sensation, and breast-associated QoL. These preliminary results suggest that neurotization during ABR may lead to increased sensation and improved QoL. We hope that these results will further the knowledge of this topic, potentially improve patient outcomes, and stimulate a discussion regarding clinical management.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.