Neurotization of the Nipple-Areola Complex during Implant-Based Reconstruction: Evaluation of Early Sensation Recovery

Abstract

Summary: The concept of sensate autologous breast reconstruction is not novel, and prior literature has focused mainly on sensate abdominally based breast reconstruction. The goal of this article is to present the authors’ results with a novel technique performing sensate implant-based reconstruction. A database was prospectively maintained for patients who underwent implant-based sensate breast reconstruction. The anterior branch of the lateral fourth intercostal is identified and preserved during the mastectomy by the breast surgeon. A processed nerve allograft is used as an interpositional graft connecting the donor nerve to the targeted nipple-areola complex. The sensory recovery process was objectively monitored using a pressure-specified sensory device. Thirteen patients underwent the proposed technique. Eight patients with 15 breasts were monitored for sensory recovery. For sensory measurement, the nipple had a mean threshold of 67.33 ± 34.48 g/nm2. The upper inner (29 ± 26.75 g/nm2) and upper outer (46.82 ± 32.72 g/nm2) nipple-areola complex quadrants demonstrated better scores during the moving test compared with the static test. Mean time between the test and surgery was 4.18 ± 2.3 months, and mean time between the second test and surgery was 10.59 ± 3.57 months. Threshold improvements were documented after the second test for all nipple-areola complex areas evaluated. This is the first study to report on early results obtained after performing sensate implant-based breast reconstruction. More studies are required to determine the long-term outcomes and impact on quality of life and to assess whether patient or breast characteristics impact the success of this procedure.

Functional and Psychosocial Outcomes following Innervated Breast Reconstruction: A Systematic Review

“…Twenty-three studies were found that met parameters for inclusion into this review. Of the studies included, seven looked primarily at DIEP flaps, 3,5-10 nine looked primarily at TRAM flaps, [11][12][13][14][15][16][17][18][19] two studies were novel implantbased studies, 20,21 and the remaining five studies dealt with other reconstructive modalities, including some where a technique was not specified. [22][23][24][25][26]…”

“…Supplemental Digital Content 3 is implant-based articles ( See table 3, Supplemental Digital Content 3 , which displays implant-based article methods. http://links.lww.com/PRSGO/C174) 20,21 and Supplemental Digital Content 4 is other included studies. 22–26 ( See table 4, Supplemental Digital Content 4, which displays other article methods.…”

Targeted Nipple Areola Complex Reinnervation: Technical Considerations and Surgical Efficiency in Implant-based Breast Reconstruction

“…Breast reinnervation for implant-based reconstruction has been described by several authors. 9 , 10 Our technique differs from current approaches in several ways. First, we aim to increase the donor axon-to-target density to maximize dermatome recovery by preserving all the nerves encountered during the mastectomy dissection.…”

“…Intercostal-to-NAC interposition allografts employed during implant reconstruction to stimulate nerve regrowth and sensory recovery have recently been reported. 9 , 10 Peled and Peled 10 first described a novel technique in which following mastectomy, transected lateral intercostal nerves are dissected and coapted to 7 cm nerve allografts that are then secured to target subareolar nerves after implant reconstruction is complete. In their pilot study of 23 breasts, 67% reported similar preoperative and postoperative breast and NAC sensation.…”

Operational and Financial Impact of COVID-19: A Survey of Plastic Surgeons in Miami

“…The substantial drop in patient access also had a significant negative impact on the financial stability of these practices and especially private practices. 15 , 16 While patient access suddenly became practically nonexistent, the financial overhead many practices carry did not change. Plastic surgeons across the board reported that they were still required to pay rent, that they were not able to obtain any sort of negotiated discount for their rented equipment such as lasers and medical devices, and that there were no plans for pharmaceutical companies to take back any unused or expiring products.…”