Is nerve coaptation associated with improved sensation after microvascular breast reconstruction? A systematic review

Abstract

Background Sensation after autologous breast reconstruction is an increasingly important outcome. Several studies demonstrated improved sensation with flap neurotization but utilized heterogenous measures and follow‐up intervals. This review evaluates sensory outcomes after neurotization using uniform, objective outcome measurements. Methods PubMed/Medline and Embase databases were queried for articles published between January 1990 and January 2022. Inclusion criteria included studies with free flap tissue transfer breast reconstruction patients and use of Semmes‐Weinstein Monofilaments (SWM) to quantify return of sensation after either neurotization or no neurotization. Reviews, case reports, and studies utilizing implants or pedicled flaps were excluded. Results Overall, 513 articles were screened. Eleven articles met inclusion criteria for a total of 474 patients. There were 254 non‐neurotized patients included as controls (Group A) and 220 neurotized patients (Group B). Mean follow‐up time was similar in both groups (22.06 months vs. 22.78 months, p > 0.05). There was no significant difference in age (Group A = 49.97 years vs. Group B = 42.47 years) or BMI (Group A = 25.48 vs. Group B = 25.97) between groups. More patients in group B received radiation therapy (Group B = 32.72% vs. Group A = 20.86%, p > 0.05). Patients that received neurotization had lower mean pressure thresholds (Group A = 38.85 gm/mm2 vs. Group B = 6.69 gm/mm2, p = 0.053) than comorbidity‐matched controls. Conclusion Neurotization has been shown to be a safe and feasible option for enhancing return of sensation after breast reconstruction. Future studies with standardized, long‐term follow‐up will further elucidate the pattern of breast sensation return and the impact of neurotization.

Patient-Reported Outcomes on Subjective Nipple Sensation After Double-Incision and Periareolar Mastectomy for Chest Masculinization

“…34 Furthermore, initial studies of breast reconstruction with microsurgical nerve coaptation have suggested that it may be associated with greater sensation recovery than nonneurotized reconstructions, and the improved sensation positively impacts quality of life. 35,36 Since the introduction of nerve coaptation in autologous breast reconstruction, techniques for NAC reinnervation with chest masculinization have been described, but with scarce previous evidence demonstrating the importance of nipple sensation to the patient population and no accompanying evidence for PROs after reinnervation. 6,25,37 While it may be feasible eventually to identify candidates for NAC reinnervation with patient characteristics that increase risk for prolonged or absent recovery of sensation (such as obesity or resection volume), further study of nipple sensation in the context of other factors that affect PROs after chest masculinization is needed.…”

“…Among breast cancer patients who underwent immediate reconstruction with nipple reconstruction, breast sensation has been found to improve with time after surgery, and preoperative factors such as older age, higher BMI, greater breast volume, and larger mastectomy weight were found to negatively impact sensation recovery 34 . Furthermore, initial studies of breast reconstruction with microsurgical nerve coaptation have suggested that it may be associated with greater sensation recovery than nonneurotized reconstructions, and the improved sensation positively impacts quality of life 35,36 . Since the introduction of nerve coaptation in autologous breast reconstruction, techniques for NAC reinnervation with chest masculinization have been described, but with scarce previous evidence demonstrating the importance of nipple sensation to the patient population and no accompanying evidence for PROs after reinnervation 6,25,37 .…”