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Breast Sensation Recovery After Neurotized Deep Inferior Epigastric Perforator Reconstruction

Scomacao, Isis MD; Duraes, Eliana F. R. MD, PhD; Knackstedt, Rebecca MD, PhD; Cakmakoglu, Cagri MD; Quereshy, Humzah BS; Schwarz, Graham S. MD; Djohan, Risal MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 18-19
doi: 10.1097/01.GOX.0000584292.22628.14
Breast Abstracts
Open

Cleveland Clinic, Cleveland, OH

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.

BACKGROUND: It has been proven that breast reconstruction and the improvement of the breast sensation for postmastectomy patients can improve both satisfaction and quality of life for patients.1 Spontaneous sensory recovery after deep inferior epigastric perforator (DIEP) flap has been showed due to ingrowth of peripheral cutaneous nerves from the wound edges or from deeper structures but usually is poor and variable. Neurotization has been used in breast reconstruction since 1992, and the limitation of only using the intercostal nerves for coaptation is the need of a greater chest dissection to have an appropriate nerve length that generates scar formation and tension on the suture line.2,3,4 Using a nerve conduit with a nerve graft will reduce excess nerve dissection that will jeopardize nerve regeneration and can help to overcome the size mismatch between the intercostal nerve and the DIEP intercostal nerve.4,3

PURPOSE: To evaluate breast sensation outcomes after combined nerve conduit and allograft in DIEP reconstructions.

METHODS: Dynamic and static sensation recovery tests were performed in all breast quadrants of consecutive patients who underwent DIEP reconstruction with neurotized (group 1) and non-neurotized DIEP reconstructions (group 2). Demographics information, surgical details, and postoperative complications were collected.

RESULTS: A total of 74 patients (96 breasts) underwent this technique since June 2016: 46 breasts from group 1 and 15 from group 2. The groups had similar age, body mass index, smoking status, history of radiation therapy, and timing of reconstruction. No difference was found for complications and reoperation between groups. The mean time interval among the surgery, first, and second tests were similar in groups 1 and 2. Thresholds on the first and second recovery tests were statistically similar. Compared to group 2, group 1 had 56% of the total areas evaluated (static and dynamic) with better sensation thresholds. On the second round of sensation tests, the clinical difference between the groups was more evident with all areas with better sensation thresholds in the neurotized group.

CONCLUSION: There is a positive trend for breast sensation recovery after reconstruction with neurotized DIEP flaps. Nerve regeneration takes time to be achieved, and a longer follow-up is necessary to evaluate the final sensation recovery.

REFERENCES:

1. Cornelissen AJM, Beugels J, van Kuijk SMJ, et al. Sensation of the autologous reconstructed breast improves quality of life: a pilot study. Breast Cancer Res Treat. 2018;167:687–695.

2. Blondeel PN, Demuynck M, Mete D, et al. Sensory nerve repair in perforator flaps for autologous breast reconstruction: sensational or senseless? Br J Plast Surg. 1999;52:37–44.

3. Spiegel AJ, Menn ZK, Eldor L, et al. Breast reinnervation: DIEP neurotization using the third anterior intercostal nerve. Plast Reconstr Surg Glob Open. 2013;1:e72.

4. Bassilios Habre S, Bond G, Jing XL, et al. The surgical management of nerve gaps: present and future. Ann Plast Surg. 2018;80:252–261.

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