Long-term breast and nipple sensation after nipple-sparing mastectomy with implant reconstruction: Relevance to physical, psychosocial, and sexual well-being

Hammond, Jacob B.; Kandi, Lyndsay A.; Armstrong, Valerie; Kosiorek, Heidi E.; Rebecca, Alanna M.; Casey, William J.; Krüger, Erwin A.; Cronin, Patricia A.; Pockaj, Barbara A.; Teven, Chad M.

doi:10.1016/j.bjps.2022.06.034

Cited by 11 publications

(15 citation statements)

References 21 publications

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“…Unfortunately, breast sensation is usually forfeited during NSM. 2,5,6 In a recent survey of 131 women who underwent either bilateral (n = 101) or unilateral (n = 30) breast reconstruction, of which 99 were direct-to-implant and 32, tissue-expander reconstructions, 106 (80.9%) claimed their reconstructed breasts remained either totally numb (n = 47, 35.9%) or had less sensation (n = 59, 45.0%) than preoperatively at a median follow-up of six years. 2 Similarly, 67 (51.1%) and 37 (28.2%) said their nipples were either totally numb or considerably less sensitive, respectively, than before surgery.…”

Section: Discussionmentioning

confidence: 99%

“…2,5,6 In a recent survey of 131 women who underwent either bilateral (n = 101) or unilateral (n = 30) breast reconstruction, of which 99 were direct-to-implant and 32, tissue-expander reconstructions, 106 (80.9%) claimed their reconstructed breasts remained either totally numb (n = 47, 35.9%) or had less sensation (n = 59, 45.0%) than preoperatively at a median follow-up of six years. 2 Similarly, 67 (51.1%) and 37 (28.2%) said their nipples were either totally numb or considerably less sensitive, respectively, than before surgery. Total breast numbness was associated with significantly-reduced physical well-being ( P = 0.048), whereas total numbness in a nipple was linked to significantly reduced physical ( P = 0.007), psychosocial ( P = 0.041), and sexual ( P = 0.002) well-being.…”

Section: Discussionmentioning

confidence: 99%

“…Total breast numbness was associated with significantly-reduced physical wellbeing (P = 0.048), whereas total numbness in a nipple was linked to significantly reduced physical (P = 0.007), psychosocial (P = 0.041), and sexual (P = 0.002) wellbeing. 2 In an earlier study of 48 women who underwent bilateral nipple-sparing (n = 33) or skin-sparing (n = 15) mastectomies, nipple sensation was lost in one or both breasts in 74% and 32% of patients, respectively, and overall satisfaction with postoperative sexual arousal was poor with both procedures. 5 For these reasons, surgeons performing NSM should do everything possible to avoid iatrogenic nerve injury.…”

Section: Meaningmentioning

confidence: 97%

“…The use of nipple-sparing mastectomies (NSM) has been steadily increasing. [1][2][3] Advantages include improved patient body image, satisfaction, life quality, and psychological adjustment, 2,4 and reduced need for multiple and/ or more complex breast-reconstruction procedures. 4 Sensory loss of the nipple-areolar complex (NAC) following NSM remains problematic, with sensation rated poor to fair or from nonexistent to markedly-reduced, relative to preoperative sensation, up to six years postoperatively.…”

Section: Introductionmentioning

confidence: 99%

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Fluorescence Imaging to Identify and Preserve Fifth Intercostal Sensory Nerves during Bilateral Nipple-sparing Mastectomies

Rancati

Angrigiani

Nahabedian³

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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The use of nipple-sparing mastectomies has increased steadily over the past 10-15 years. However, one major source of patient dissatisfaction with both skin-and nipple-sparing mastectomies is lost skin and/or nipple sensation postoperatively due to intraoperative, iatrogenic sensory nerve injury. We summarize the case of a 41-year-old woman with BRCA(+) breast cancer who underwent bilateral, risk-reducing nipple-sparing mastectomies, immediately followed by bilateral, direct-to-implant breast reconstruction, in whom a prototype fluorescent imaging camera was used to facilitate sensory nerve identification and preservation. Preoperatively, tactile and thermal quantitative sensory testing were performed using a 30-gauge needle to determine baseline sensory function over both breasts. Then, nipple-sparing mastectomies and direct-to-implant reconstruction were performed. Using a laterally-displaced submammary approach, the anterior intercostal artery perforator neurovascular pedicle was preserved. Then a prototype camera, which emits near-ultraviolet light, was used to detect nerve autofluorescence. Intraoperatively under near-ultraviolet light, both the fifth intercostal nerve and its sensory branches auto-fluoresced clearly, so that surgery was completed without apparent injury to the fifth intercostal nerve or any of its branches. Postoperatively, the patient reported full sensory function throughout both breasts and both nipple-areolar complexes, which was confirmed on both tactile and thermal sensory testing at 3-month follow-up. The patient experienced no complications and rated her overall satisfaction with surgery on both breasts as 10 out of 10. To our knowledge, this is the first time sensory nerve auto-fluorescence has been reported to reduce the likelihood of intraoperative, iatrogenic nerve injury and preserve sensory function.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Meaningmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Fluorescence Imaging to Identify and Preserve Fifth Intercostal Sensory Nerves during Bilateral Nipple-sparing Mastectomies

Rancati

Angrigiani

Nahabedian³

et al. 2023

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

show abstract

“…This leads to diminished or complete sensory loss, which can negatively impact patients' quality of life postoperatively. 1 In our experience, attempting to restore sensation to the NAC presents relatively minimal risk to patients. We believe that attempts at preservation and restoration of NAC sensation should be offered to women undergoing nipple-sparing mastectomy, where resources permit.…”

mentioning

confidence: 88%