Evaluation of Sensation on Mastectomy Skin Flaps following Immediate Breast Reconstruction

Doğan, Zekeriya; Farhadi, Jian

doi:10.1055/s-0040-1702157

Cited by 14 publications

(11 citation statements)

References 31 publications

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“…Khan et al 13 compared immediate implant reconstructions with immediate latissimus dorsi with implant reconstructions and detected no significant difference in breast sensation between groups. Akdeniz Dogan and Farhadi 14 showed that, unlike the results of the present study, the percentage of patients in the autologous group reporting no sensation was higher in some areas compared with the implant group, which indicates better preservation of sensation in the implant group. However, the mastectomy types and radiation used in the autologous group are not clear 14 .…”

Section: Discussioncontrasting

confidence: 96%

A Comparative Study of Breast Sensibility and Patient Satisfaction After Breast Reconstruction

Hwang

Lee²,

Park³

et al. 2022

Ann Plast Surg

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Background: Currently, a variety of treatment modalities are implemented for breast reconstruction. However, clinical prognosis regarding sensory regeneration of the breast and patient-reported satisfaction remains underexamined. In this study, we aimed to compare breast sensibility after various reconstruction. Methods: We conducted a retrospective comparative study of all patients who underwent breast reconstruction between August 2016 and October 2019 at our institution. Acellular dermal matrixes were used to cover the implant inferolaterally in a dual-plane subpectoral approach and to wrap the implant in prepectoral direct to implant (DTI). The cutaneous tactile pressure threshold and patient satisfaction outcome were tested. Results: A total of 105 breasts were assessed, 30 breasts reconstructed with deep inferior epigastric perforator (DIEP) flap, 40 breasts reconstructed with 2-stage subpectoral implant, and 35 breasts reconstructed with prepectoral DTI. In the specific group-to-group analysis, DIEP and implant groups showed significant differences in sensory recovery, mainly in lateral areas of the reconstructed breast. In 2-stage reconstruction and DTI groups, there were no statistically significant differences. When comparing patient groups using only patients with follow-up lengths of more than 12 months, the difference was more clearly indicated ( P = 0.049). Better sensory recovery predicted high satisfaction scores in patient-reported outcomes ( P = 0.007). Conclusions: We found that subpectoral implant reconstruction and DTI show no statistically significant differences in sensory recovery, and autologous DIEP flap reconstruction results in a better prognosis than prosthesis implant reconstruction. Furthermore, the clarity of the differences increased when the followup length was longer than 12 months. Better patient-reported satisfaction was associated with good breast sensibility.

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Section: Discussioncontrasting

confidence: 96%

A Comparative Study of Breast Sensibility and Patient Satisfaction After Breast Reconstruction

Hwang

Lee²,

Park³

et al. 2022

Ann Plast Surg

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“…Within autologous reconstruction, DIEP flaps recover in the most sensate manner, followed by TRAM flaps, and then LD flaps. 22 One hypothesis proposed is the delay in neural healing across the thickness of autologous flap tissue relative to implant-based reconstruction with tissue expanders. 23 This could also be explained by the improved sensation in implant-based reconstruction relative to autologous breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…20 A comparison of nipple-sparing mastectomy has shown improved light touch and pleasure sensation relative to skin-sparing mastectomy, which could lead to a reduced incidence of thermal injury in nipplesparing mastectomy relative to skin-sparing mastectomy. 21 Unfortunately, our literature review possessed limited data with regard to the type of mastectomy.…”

Section: Discussionmentioning

confidence: 99%

Solar Burns to the Reconstructed Breast: A Rare Complication following Breast Reconstruction

Romanelli

Daugherty

Sommer

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Burns to the breast are a rare complication after breast reconstruction. Decreased sensation and radiation therapy may contribute to the development of burns. Solar burns may also be related to wearing dark-colored clothing. This literature review aims to analyze the incidence of solar burns on alloplastic and autologous breast reconstruction following mastectomy. Also included is the first published report of a delayed breast burn years after alloplastic reconstruction. Methods: A PubMed literature search of articles was performed using the search formula “burns” AND “breast reconstruction.” Abstracts were evaluated for relevance based on inclusion and exclusion criteria. Pertinent reference bibliographies were then screened for additional relevant resources. Results: The PubMed search resulted in 598 articles, of which 12 met inclusion criteria with 22 cases of solar burns to reconstructed breasts (23 including the addition of our case report). Five occurred following alloplastic reconstruction with 80% of these patients radiated and 100% wearing dark clothing. The remaining 18 patients had autologous reconstruction with 50% wearing dark clothing. Twenty-two percent of patients in the autologous group required surgical debridement as compared to 40% of the alloplastic group. Conclusions: Solar burns in autologous and alloplastic breast reconstruction, while rare, pose significant complications in the reconstructed breast and appear to be exacerbated by radiation and dark-colored clothing. Patients should be counseled accordingly with discussion of this potential risk in a comprehensive informed consent, and precautions should be recommended to avoid this type of injury.

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“…21 However, in a study of 59 breasts in 40 women, Zeynep and Farhadi demonstrated that none of the patients reported normal sensation regardless of mastectomy type (nipple sparing or skin sparing) nor demonstrated any light touch sensation. 22 Other authors advocate that the higher quality of sensibility recovery in sensate breast reconstruction outweighs the risk of additional operating time. 7 Furthermore, systematic review has demonstrated that innervated flaps do seem to lead to greater sensate recovery at an earlier stage than noninnervated flaps.…”

Section: Discussionmentioning

confidence: 99%

A Cadaveric Anatomical and Histological Study of Recipient Intercostal Nerve Selection for Sensory Reinnervation in Autologous Breast Reconstruction

Mohan

Suchyta

Lachman

et al. 2020

J Reconstr Microsurg

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Background Autologous breast reconstruction (ABR) has grown in popularity due to improved aesthetic and long-term patient reported outcomes, but data regarding sensory reinnervation of autologous flaps remain limited. Traditionally, the lateral cutaneous branch of the fourth intercostal nerve has been used for flap neurotization, but the use of the anterior cutaneous branch of the intercostal nerves (ACB) offer a more optimal location to the microsurgical field when using internal mammary vessels for the microanastomosis. This study aimed to evaluate the optimum ACB recipient site level for sensory nerve coaptation in ABR. Methods Twelve hemi-chests were dissected from six fresh cadaveric females. Costal cartilages were removed and the anterior cutaneous intercostal nerve (ACB) and the lateral (subcutaneous) division of the anterior cutaneous branch (LACB) of the intercostal nerve were exposed. Anatomical measurements were recorded, and nerve samples were evaluated histologically with carbonic anhydrase staining to differentiate sensory fascicles. Assessment of fascicular diameter, axonal counts, and fascicular area were compared. Results A total of 75 nerve specimens were assessed. The ACB was identified at all levels (100%) and the subcutaneous LACB was noted consistently in the second to fourth rib space (96% cadavers), with a median length of 43, 37.5, and 37 mm, respectively. Across all rib spaces, the fascicular and axonal counts were comparable between the LACB and ACB. Nerves in the second intercostal space had a significantly larger mean fascicular area mean (112,816 ± 157,120 µm2) compared with that in the fourth (mean 26,474 ± 38,626 µm2), p = 0.03. Axonal count of sensory fascicles was the highest in the second intercostal nerves (p < 0.05). Conclusion This study provides anatomical and histological basis to determine the optimum recipient site choice for sensory coaptation in microsurgical breast reconstruction. This would aid in operative decision-making regarding the ideal recipient anterior cutaneous intercostal nerve branches for recipient site coaptation in ABR.

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Evaluation of Sensation on Mastectomy Skin Flaps following Immediate Breast Reconstruction

Cited by 14 publications

References 31 publications

A Comparative Study of Breast Sensibility and Patient Satisfaction After Breast Reconstruction

A Comparative Study of Breast Sensibility and Patient Satisfaction After Breast Reconstruction

Solar Burns to the Reconstructed Breast: A Rare Complication following Breast Reconstruction

A Cadaveric Anatomical and Histological Study of Recipient Intercostal Nerve Selection for Sensory Reinnervation in Autologous Breast Reconstruction

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