Sensory change of the reconstructed breast envelope after skin-sparing mastectomy

Khan, Aadil; Zhang, J.; Sollazzo, Viviana; Mohammed, Kabir; Gui, Gerald

doi:10.1016/j.ejso.2016.03.018

Cited by 40 publications

(39 citation statements)

References 19 publications

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“…14,15,17 Khan et al compared their immediate implant reconstructions to immediate latissimus dorsi with implant reconstructions and demonstrated no significant difference in sensation of the breast envelopes. 20 In the present study, we were only able to show weak association between the reconstruction type and breast skin sensibility, which was limited to UL quadrant. This may be explained by, as mentioned above, the fact that skin sensation recovery is more dependent on sprouting from the sides and independent of the reconstruction type.…”

Section: Discussioncontrasting

confidence: 65%

“…These results are consistent with the findings in the literature. [19][20][21] Stromps et al have looked at spontaneous reinnervation of deep inferior epigastric perforator (DIEP) flap, investigating the recovery of different sensory qualities in delayed reconstruction. 31 They have shown that the transition zone along the border between the mastectomy skin and DIEP flap had better sensibility and played the primary role in sensory recovery.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were asked to fill out the following questionnaire before the examination (modified from Khan et al) 20 to assess their perception of sensation.…”

Section: Questionnairementioning

confidence: 99%

“…Several studies have investigated whether the type of mastectomy had an impact on the sensation of breast skin. [18][19][20][21] A few studies have addressed the influence of reconstruction type on the mastectomy skin flap sensation. 20,22 Since it has been shown that breast sensation is associated with a better quality of life, 23 it is important to lay out variables that influence the sensibility of the reconstructed breast.…”

mentioning

confidence: 99%

“…[18][19][20][21] A few studies have addressed the influence of reconstruction type on the mastectomy skin flap sensation. 20,22 Since it has been shown that breast sensation is associated with a better quality of life, 23 it is important to lay out variables that influence the sensibility of the reconstructed breast. The aim of this study is to evaluate factors which have an impact on the sensation of the native mastectomy skin flaps in immediate breast reconstruction and patients' own perception regarding overall breast skin sensation.…”

mentioning

confidence: 99%

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Evaluation of Sensation on Mastectomy Skin Flaps following Immediate Breast Reconstruction

Doğan

Farhadi

2020

J Reconstr Microsurg

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Background During a subcutaneous mastectomy, nerves are severed and patients lose sensation on the breast skin. The aim of this study is to investigate factors that have impact on the sensation of the mastectomy flaps and patients' own perception regarding overall breast skin sensation. Patients and Methods Patients who have undergone skin sparing or nipple sparing mastectomy with immediate reconstruction with either an implant or autologous tissue were included. Sensory assessment was performed at least 12 months after surgery using Semmes–Weinstein monofilaments (Aesthesio, San Jose, CA). The breast envelope was divided into four quadrants, and one measurement from each quadrant was recorded. Patients were also asked to fill out a questionnaire before the examination. Results A total of 59 breasts in 40 women were examined. In lower medial quadrant, significantly more patients reported “no sensation” in the radiated group than the nonradiated group. In upper medial quadrant and lower lateral quadrant, patients with NSM reported better sensation than patients with skin sparing mastectomy (SSM). Conclusion Vascularized tissue did not improve sensory recovery. There was no relationship between sensation and the preoperative cup size and the number of revision surgeries. Irradiation was associated with higher sensory thresholds in lower medial quadrant. Nipple sparing mastectomy was associated with lower sensory thresholds in two quadrants compared to SSM. Independent of all variables none of the patients reported normal sensation.

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Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

“…Patients were asked to fill out the following questionnaire before the examination (modified from Khan et al) 20 to assess their perception of sensation.…”

Section: Questionnairementioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluation of Sensation on Mastectomy Skin Flaps following Immediate Breast Reconstruction

Doğan

Farhadi

2020

J Reconstr Microsurg

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Patient and procedure characteristics associated with postoperative pain after prophylactic versus therapeutic ambulatory bilateral breast surgery

Simón

Assel

Serafin

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivesWe investigated whether age, body mass index (BMI), and tissue expander placement were related to postoperative opioid requirement for patients undergoing therapeutic versus prophylactic breast surgery.MethodsPostoperative opioid consumption was evaluated for patients who underwent bilateral mastectomy with immediate implant‐based reconstruction at a freestanding ambulatory cancer surgery center between 2016 and 2021. Ordinal regression tested whether surgical indication was associated with increased postoperative opioid requirements after adjusting for age, BMI, and tissue expander placement.ResultsOf 2447 patients, 6% underwent prophylactic surgeries. Therapeutic mastectomy patients had lower postoperative opioid requirement (OR = 0.67; 95% CI: 0.50−0.91; p = 0.030), but this was not significant after adjusting for covariates (OR = 0.75; 95% CI: 0.53−1.07; p = 0.2). Opioid use increased with higher BMI (OR = 1.06; 95% CI: 1.05−1.08; p < 0.001) and decreased with age (OR = 0.97; 95% CI: 0.96−0.98; p < 0.001) with therapeutic mastectomy patients being older (median 46 vs. 39). The subpectoral tissue expander group had nearly double the postoperative opioid requirement compared to prepectoral placement (OR = 1.86; 95% CI: 1.55−2.23; p < 0.001).ConclusionsIncreased postoperative opioid requirement in women undergoing prophylactic procedures is best explained by age. Mastectomy patients should be counseled similarly about postoperative pain irrespective of indication. A larger prophylactic mastectomy sample is required to provide more precise estimates.

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

et al. 2022

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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.

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Sensory change of the reconstructed breast envelope after skin-sparing mastectomy

Cited by 40 publications

References 19 publications

Evaluation of Sensation on Mastectomy Skin Flaps following Immediate Breast Reconstruction

Evaluation of Sensation on Mastectomy Skin Flaps following Immediate Breast Reconstruction

Patient and procedure characteristics associated with postoperative pain after prophylactic versus therapeutic ambulatory bilateral breast surgery

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

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