The clinical relevance of sensory nerve coaptation in DIEP flap breast reconstruction evaluated using the BREAST-Q

Abstract

Background: Sensory nerve coaptation in autologous breast reconstruction positively affects sensory recovery in the reconstructed breast. However, patient-reported outcomes are lacking and no conclusions on the clinical relevance of nerve coaptation could be drawn. The aim of this study was to evaluate the clinical relevance of nerve coaptation in deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods: A prospective cohort study was conducted of patients undergoing innervated or noninnervated DIEP flap breast reconstruction between August of 2016 and August of 2018. Patients completed a BREAST-Q questionnaire at a minimum of 12 months’ follow-up in combination with either a preoperative questionnaire or a questionnaire at 6 months’ follow-up. The physical well-being of the chest domain was the primary outcome and patients answered additional sensation-specific questions. Sensation was measured using Semmes-Weinstein monofilaments. Results: In total, 120 patients were included (65 innervated and 55 noninnervated reconstructions). A clinically relevant difference was found in BREAST-Q scores in favor of patients with innervated reconstructions in general and for delayed reconstructions specifically. Patients with sensate breast reconstruction more often reported better and pleasant sensation. Conclusions: This study demonstrated that nerve coaptation in DIEP flap breast reconstruction, specifically in delayed reconstruction, resulted in clinically relevant improved patient-reported outcomes on the physical well-being of the chest domain of the BREAST-Q and that better sensation was perceived. However, the BREAST-Q does not address sensation adequately, and the introduction and validation of new scales is required to confirm the clinical relevance of nerve coaptation reliably. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Bridging the Gap: A Pilot Study on the Efficacy of Nerve Allografts in Autologous Breast Reconstruction

“…These findings are in line with many previous studies which have found significant correlation between increased breast sensitivity and increased BREAST-Q scores and patient-reported quality of life. 31,32,33 Although not significant, psychosocial and sexual wellbeing scores also increased. There is a myriad of reasons for this, and many of which are patient-dependent, but it is likely that oncologic treatments likely played a not insignificant role in the lower absolute increases for these two categories.…”

“Spin” in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

“…1). 15–91 A list of all included studies is available in Supplemental Digital Content 3. ( See table, Supplementary Digital Content 3 , which displays characteristics and references of all included studies.…”

Sensory recovery and the role of innervated flaps in autologous breast reconstruction—a narrative review

“…A larger and prospective follow-up study confirmed that quality of life improves in patients with innervated DIEP flap breast reconstruction. On average, patients with immediate and delayed innervated DIEP flap breast reconstruction score higher on the BREAST-Q domain “Physical Wellbeing Chest” compared with their non-innervated counterparts ( 9 ). Multiple other studies have aimed to assess sensation as a patient-reported outcome, however, in the vast majority, unspecific and non-validated measures were applied that poorly reflect qualitative appraisal of sensation in reconstructed breasts ( 87 ).…”

“…In the last decade, a renewed interest in sensory recovery after breast reconstruction resulted in vastly increasing public and scientific interest. Currently, sensory nerve coaptation is increasingly considered a meaningful addition to modern era autologous breast reconstruction, both in immediate as well as delayed autologous breast reconstruction ( 9 ). Multiple systematic reviews unanimously demonstrate that sensory nerve coaptation improves postoperative breast sensation, and secondarily improves patient-reported quality of life ( 10 - 14 ).…”