Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation

Abstract

Background Patient satisfaction after breast reconstruction is dependent on both esthetics and functional outcomes. In an attempt to improve breast sensibility, a sensory nerve coaptation can be performed. The aim of this study was to objectify the sensory recovery in patients who, by chance, underwent bilateral autologous breast reconstruction with one innervated and one non-innervated flap. It must be emphasized that the intention was to coaptate the sensory nerves on both sides. Methods The cohort study was carried out in the Maastricht University Medical Center between August 2016 and August 2018. Patients were eligible if they underwent bilateral non-complex, autologous breast reconstruction with unilateral sensory nerve coaptation and underwent sensory measurements using Semmes-Weinstein monofilaments at 12 months of follow-up. Sensory outcomes were compared using t tests. Results A total of 15 patients were included, all contributing one innervated and one non-innervated flap. All patients had a follow-up of at least 12 months, but were measured at different follow-up points with a mean follow-up of 19 months. Sensory nerve coaptation was significantly associated with better sensation in the innervated breasts and showed better sensory recovery over time, compared to non-innervated breasts. Moreover, the protective sensation of the skin can be restored by sensory nerve coaptation. Conclusions The study demonstrated that sensory nerve coaptation leads to better sensation in the autologous reconstructed breast in patients who underwent bilateral breast reconstruction and, by chance, received unilateral sensory nerve coaptation.

The role of neurotization in autologous breast reconstruction: Can reconstruction restore breast sensation?

“…Neurotization was unable to be established as an independent predictor of sensation in DIEP flaps, due to limited sample sizes. Sensory recovery of reconstructed breasts was often significantly associated with length of follow‐up in both innervated and noninnervated cohorts, which is consistent with the expected natural history of sensory regeneration 15,21,22 …”

Functional and Psychosocial Outcomes following Innervated Breast Reconstruction: A Systematic Review

“…Twenty-three studies were found that met parameters for inclusion into this review. Of the studies included, seven looked primarily at DIEP flaps, 3,5–10 nine looked primarily at TRAM flaps, 11–19 two studies were novel implant-based studies, 20,21 and the remaining five studies dealt with other reconstructive modalities, including some where a technique was not specified. 22–26…”

“…6 The best nerve for coaptation is generally decided based on its vicinity to the perforator vessels and its ability to create a tensionless connection while also considering equal diameters of both recipient and donor nerves. 7 The effects of perioperative radio/chemotherapy on the return of breast sensation indicate that these treatments likely do not have a significant effect on the return of sensation following mastectomy and reconstruction. Several studies assessing various proposed factors affecting sensory recovery have shown that on univariate and multivariate analysis, previous radiation and chemotherapy is not significantly associated with post-reconstruction sensation.…”

“…Supplemental Digital Content 1 includes methods from DIEP reconstruction articles. 3,[5][6][7][8][9][10]…”

Comment: “The role of neurotization in autologous breast reconstruction: Can reconstruction restore breast sensation?”

“…We appreciate the fact that the authors differentiate the neurorrhaphy methods, with single or double anastomoses. However, referring to Bijkerk et al 3 would have been appropriate when discussing the length of the procedure. Vartanian et al 1 reported that the overall success in this procedure varies between 65% and 95% and that it increases surgery duration by at least 30 min.…”