Sensitivity of Breasts Reconstructed with the Autologous Latissimus Dorsi Flap

Abstract

The purpose of this study was to measure, both objectively and subjectively, the sensitivity of breasts reconstructed with the autologous latissimus dorsi flap and to compare these results with those of other reconstruction techniques, especially the transverse rectus abdominis myocutaneous flap. The study population included 50 patients with autologous latissimus dorsi flap breast reconstruction; these patients had an average age of 51 years and an average follow-up of 27 months. Patients answered a seven-item questionnaire that attempted to define the sensitivity of the reconstructed and opposite breasts. This sensitivity was then measured objectively using standard techniques for heat, cold, and tactile sensations. After statistical analysis, these results were compared with those published for other reconstruction techniques. Overall results were comparable or superior to those published for other techniques for autologous breast reconstruction. A total of 56 percent of patients had fine or very fine sensitivity, but 70 percent deemed this sensitivity to be less than that of the opposite breast. A total of 94 percent of patients perceived the reconstructed breast as integral to their body image. The superior medial part of the breast had the greatest sensitivity, both objectively and subjectively. Autologous latissimus dorsi breast reconstruction, a good technique with excellent aesthetic results, affords satisfactory sensitivity. This is yet another advantage of the technique.

Impact of skin-sparing mastectomy with immediate reconstruction and breast-sparing reconstruction with miniflaps on the outcomes of oncoplastic breast surgery

“…The interposition of a prosthesis and a myocutaneous flap may retard or prevent direct reinnervation of the overlying skin, limiting any recovery of sensation to the peripheral zone of the breast envelope 24 . Spontaneous recovery of sensation has been recorded after total mastectomy and myocutaneous flap reconstruction 25 , in contrast to the limited recovery seen in this study. Skin-sacrificing mastectomy excises much of the insensate skin that is preserved during SSM, and this may help to explain the observed differences.…”

Pilot study of breast sensation after breast reconstruction: Evaluating the effects of radiation therapy and perforator flap neurotization on sensory recovery

“…As one of the erogenous areas of the human body, and responsible in part for sexual arousal, the breast plays a major role in a woman's life and psychologic health. Several studies have investigated the return of sensation on the breast after aesthetic and reconstructive surgery . From our anecdotal experience, our patient population is particularly concerned about a satisfactory outcome in terms of sexual sensation and arousal from the reconstructed breast.…”

“…During mastectomy, these nerves are divided, leading to poor sensation in the residual adipocutaneous flaps. In an effort to improve postoperative breast sensation, plastic surgeons have been attempting to neurotize flaps during breast reconstruction . Usually, neurotization of abdominal flaps is performed by coaptating the fourth or fifth intercostal nerve to the T10–T12 thoracoabdominal nerve .…”

“…Several studies have investigated the return of sensation on the breast after aesthetic [1][2][3][4][5][6][7][8][9] and reconstructive surgery. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] From our anecdotal experience, our patient population is particularly concerned about a satisfactory outcome in terms of sexual sensation and arousal from the reconstructed breast. Despite increased interest, however, studies have still failed to draw consistent conclusions in terms of actual return of sensation and patient satisfaction.…”

“…In an effort to improve postoperative breast sensation, plastic surgeons have been attempting to neurotize flaps during breast reconstruction. [11][12][13]15,16,23,24,[27][28][29] Usually, neurotization of abdominal flaps is performed by coaptating the fourth or fifth intercostal nerve to the T10-T12 thoracoabdominal nerve. 24,29 Although outcomes after reinnervation are not always predictable, 12 there is a trend toward improved and more rapid return of sensation after flap neurotization than in non-neurotized flaps.…”