Comparing Breast Sensation between Alloplastic and Autologous Breast Reconstruction Patients using the BREAST-Q Sensation Module

Abstract

Background: Sensory recovery of the breast is a compelling frontier in comprehensive postmastectomy breast reconstruction. This study uses the BREAST-Q Sensation Module to evaluate the differences in women who underwent an alloplastic versus autologous breast reconstruction. Methods: Women with a history of breast cancer and postmastectomy breast reconstruction were recruited through the Love Research Army, United States. Participants completed the BREAST-Q Sensation Module, which consists of three scales: Breast Symptoms, Breast Sensation, and Quality of Life Impact. Descriptive statistics and multiple linear regression analyses were used to compare outcomes between women undergoing alloplastic or autologous breast reconstruction. Results: Of 1204 respondents, 933 were included for analysis: 620 (66.5 percent) underwent alloplastic reconstruction and 313 (33.5 percent) underwent autologous reconstruction. The average age and body mass index were 59.2 ± 10.1 years and 26 ± 5 kg/m2, respectively. Autologous reconstruction patients scored an average of 6.1 points (95 percent CI, 3.9 to 8.4; p < 0.001) and 5.3 points (95 percent CI, 2.5 to 8.1; p = 0.001) higher on the Breast Symptoms and Quality of Life Impact scales, respectively. No difference (0.0 points, 95 percent CI, −2.9 to 3.0; p = 0.75) was observed for the Breast Sensation scale. Increased time since reconstruction had a positive impact on Breast Symptoms scale scores. Radiotherapy negatively affected scores on both Breast Symptoms and Quality of Life Impact scales. Conclusions: Autologous breast reconstruction may be associated with fewer abnormal breast sensations and better sensation-related quality of life in comparison to alloplastic reconstruction. This information can be incorporated during preoperative patient counseling when discussing reconstructive options.

An Evolving Landscape

“…These results validate former studies comparing postmastectomy sensation between autologous and alloplastic cohorts. 7,9,20 A likely component of the improved sensation in the autologous cohort was the neurotization of the abdominal flap to the third intercostal nerve using a nerve allograft. Djohan et al 22 demonstrated that breasts reconstructed with abdominal flaps which have been neurotized in a similar fashion develop increased sensation compared with nonneurotized controls.…”

“…[6][7][8] The breasts play a critical role in a woman's sexual health and self-image; previous studies on patient-reported outcomes using the BREAST-Q survey have found that restoring breast sensation can significantly improve quality of life. 9,10 Furthermore, the lack of protective sensation can predispose patients to injury; for example, thermal burns from common household items due to breast numbness have been reported in the literature. 11,12 Previous studies on breast sensation have elucidated the effects of mastectomy and reconstructive techniques on sensation, as well as the impact of neurotization techniques in both autologous and alloplastic reconstruction.…”

“…11,12 Previous studies on breast sensation have elucidated the effects of mastectomy and reconstructive techniques on sensation, as well as the impact of neurotization techniques in both autologous and alloplastic reconstruction. 9,[13][14][15][16][17][18] Although many studies have quantitatively measured breast sensation in multiple anatomic regions, few have reported on region-specific findings. Using Semmes-Weinstein monofilaments, Bijkerk et al and Hwang et al both reported increased sensation in the medial breast compared with the lateral breast, in both alloplastic and autologous reconstruction.…”

“…Regardless of reconstructive method, breast numbness and poor sensory return remain an ongoing issue in breast reconstruction 6–8 . The breasts play a critical role in a woman's sexual health and self-image; previous studies on patient-reported outcomes using the BREAST-Q survey have found that restoring breast sensation can significantly improve quality of life 9,10 . Furthermore, the lack of protective sensation can predispose patients to injury; for example, thermal burns from common household items due to breast numbness have been reported in the literature 11,12 …”

Impact of Comorbidities on Sensory Return After Breast Reconstruction

“…9 As shown in previous studies using the BREAST-Q sensation module, restoring breast sensation can significantly impact quality of life. 10 Furthermore, breast anesthesia can also lead to incidental injuries, such as trauma and burns, because of the lack of sensory feedback and disrupted regulation of blood flow's thermal dynamics in anesthetized skin. 11,12 In our previous study, we explored differences in sensory recovery between neurotized deep inferior epigastric perforator (DIEP) flap reconstruction and implant-based reconstruction.…”