Predictable Location of Breast Sensory Nerves for Breast Reinnervation

Abstract

Summary: The sensory innervation to the breast originates from the medial and lateral cutaneous branches of the third to fifth intercostal nerves, which are at risk for injury or loss during mastectomy. Providing reinnervation after mastectomy was introduced almost 20 years ago, but it is not widely performed, perhaps because of the difficulty of locating a recipient nerve. The authors have performed cadaveric dissections to allow for precise anatomical localization of the lateral intercostal branch providing breast sensation. Bilateral chest dissections were performed on 10 female cadavers. The lateral intercostal nerve providing sensation to breast tissue was identified. The distances from the sternum, the midclavicular line, and the lateral pectoralis minor—in addition to nerve diameter—were measured. The nerve was successfully identified bilaterally in all cadavers. The majority of nerves (16 of 20) exited from under the fourth rib. The average distance from the sternum was 13.1 ± 1.3 cm (range, 10 to 15 cm) and the average distance from the midclavicular line was 11.8 ± 2.2 cm (range, 8 to 16 cm). The nerve exited at the lateral border of the pectoralis minor or within 2 cm from the lateral border for all cadavers. The diameter of the nerve was consistently 2 mm. The nerve traveled under the thoracodorsal vessels, aiding in identification. The authors identified the predictable location of the lateral intercostal nerve providing sensation to the breast. The authors hope that by enabling surgeons to locate this nerve, more well-conducted studies will be performed investigating techniques and outcomes for breast reinnervation.

The effect of ultrasound-guided serratus plane block on the quality of life in patients undergoing modified radical mastectomy and axillary lymph node dissection: a randomized controlled study

“…At the first month, 10% of the patients in both groups showed a high probability of a neuropathic pain component. At this evaluation time, the mean PDQ score was 9 (3-21) for the control group and 8.5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) for the SPB group, with no statistically significant difference between the groups (P = 0.764). When PDQ was evaluated at the sixth month, 10% of the patients in both groups showed a high probability of a neuropathic pain component, with the mean PDQ score being determined as 8 (0-22) and 7.0 (0-22) for the control and SPB groups, respectively (P = 0.684) (Table 5).…”

The Effect of Ultrasound Guided Superficial Serratus Plane Block For Acute Post mastectomy Pain After Modified Radical Mastectomy and Axillary Lymph Node Dissection: A Randomized Controlled Study

“…Sternumun duyusu ise interkostal sinirlerden sternal alanda dal alan anterior kütanöz sinirlerle sağlanır. Pektoral ve aksiller alan innervasyonunda ise interkostobrakial sinirler ve brakial pleksusdan dal alan torakodorsal ve torasikus longus sinirleri yer alsa da pektoral ve aksiller doku innervasyonları tam olarak anlaşılamamıştır (6) .…”

Collaboration between the breast and plastic surgeon in restoring sensation after mastectomy

“…Thus, the anterior intercostal nerve is more commonly utilized, especially as this nerve is typically in the microsurgical field and does not require additional dissection. Our group recently published a cadaveric study characterizing the location of the lateral intercostal nerve at the lateral 4th intercostal space to allow for ease of dissection . When utilizing the lateral intercostal nerve, long lengths of the abdominal sensory nerve are required for direct coaptation.…”

“…Our group recently published a cadaveric study characterizing the location of the lateral intercostal nerve at the lateral 4th intercostal space to allow for ease of dissection. 24 When utilizing the lateral intercostal nerve, long lengths of the abdominal sensory nerve are required for direct coaptation. However, the introduction of cadaveric nerve grafts and conduits has allowed for the development of new techniques and a resurgence of interest in utilizing this nerve.…”