Sensory Recovery of the Breast following Innervated and Noninnervated DIEP Flap Breast Reconstruction

Beugels, Jop; Cornelissen, Anouk J. M.; Kuijk, Sander M. J. van; Lataster, Arno; Heuts, E. M.; Piatkowski, Andrzej; Spiegel, Aldona J.; Hulst, René R. W. J. van der; Tuinder, Stefania

doi:10.1097/prs.0000000000005802

Cited by 56 publications

(89 citation statements)

References 29 publications

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“…To restore sensation in the reconstructed breast, a sensory nerve coaptation can be performed during autologous breast reconstruction. Promising results have been demonstrated with better sensation in women who received innervated deep inferior epigastric perforator (DIEP) flaps, compared to women who received non-innervated DIEP flaps [6]. The primary aim of this study was to evaluate sensory recovery in the reconstructed breasts of patients who underwent bilateral autologous breast reconstruction with only a unilateral sensory nerve coaptation.…”

Section: Introductionmentioning

confidence: 99%

Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation

Bijkerk

Kuijk

Lataster

et al. 2020

Breast Cancer Res Treat

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Background Patient satisfaction after breast reconstruction is dependent on both esthetics and functional outcomes. In an attempt to improve breast sensibility, a sensory nerve coaptation can be performed. The aim of this study was to objectify the sensory recovery in patients who, by chance, underwent bilateral autologous breast reconstruction with one innervated and one non-innervated flap. It must be emphasized that the intention was to coaptate the sensory nerves on both sides. Methods The cohort study was carried out in the Maastricht University Medical Center between August 2016 and August 2018. Patients were eligible if they underwent bilateral non-complex, autologous breast reconstruction with unilateral sensory nerve coaptation and underwent sensory measurements using Semmes-Weinstein monofilaments at 12 months of follow-up. Sensory outcomes were compared using t tests. Results A total of 15 patients were included, all contributing one innervated and one non-innervated flap. All patients had a follow-up of at least 12 months, but were measured at different follow-up points with a mean follow-up of 19 months. Sensory nerve coaptation was significantly associated with better sensation in the innervated breasts and showed better sensory recovery over time, compared to non-innervated breasts. Moreover, the protective sensation of the skin can be restored by sensory nerve coaptation. Conclusions The study demonstrated that sensory nerve coaptation leads to better sensation in the autologous reconstructed breast in patients who underwent bilateral breast reconstruction and, by chance, received unilateral sensory nerve coaptation.

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Section: Introductionmentioning

confidence: 99%

Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation

Bijkerk

Kuijk

Lataster

et al. 2020

Breast Cancer Res Treat

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“…Without much concern to the survival, attentions gradually shift to the overall quality of reconstruction with restoration of sensation clearly becoming a very important consideration. Restoration of sensation after flap coverage is particularly helpful in improving the life quality of patients in certain parts, for example, the finger pulps that need acute sensitivity, 3,4 the heel that bears the body weight, 5,6 the breasts that play the function of “sexual arousal,” 7,8 and the oral cavity that is in frequent contact with hot food 9,10 …”

Section: Introductionmentioning

confidence: 99%

“…However, clear shortcomings exist in these previous studies with key questions unanswered. In clinical studies, approaches such as two‐point discrimination are commonly adopted for assessment of sensate return with a scarcity of morphological supports due to the intrinsic difficulties of sampling flap tissues from patients 7,8,11,12 . In animal studies, qualitative morphological descriptions without quantification of axonal ingrowth and functional regain are the common approaches adopted 13‐16 .…”

Section: Introductionmentioning

confidence: 99%

Quantification of axonal ingrowth and functional recovery in a myocutaneous flap model in rats with strong clinical implications

Xie

Fang

Ping³

et al. 2020

Wound Repair Regeneration

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The process of reinnervation, an important component of functional restoration after flap transfer, is understudied, making it necessary to carry out a further investigation for delineation of the exact timeline. Seventy‐six Sprague‐Dawley rats were used as the experimental animals. An anatomic study was first conducted to clarify the pattern of nerve distribution in the dorsal skin of 16 rats. Afterward, a myocutaneous flap was harvested on the right flanks of 40 rats, which were then assigned into seven time points. At each time point, skin samples were harvested and immunofluorescent staining was performed using α‐Bungarotoxin, and antibodies against NF‐200, p75, α‐SMA, and TH. One‐way analysis of variance was adopted for comparison of nerve density after surgery. For evaluation of functional return, cutaneous trunci muscle reflex (CTMr) test was performed on 10 additional rats, and the Chi‐square test was used for comparison of reflex intensity among six time points after surgery. The outcomes revealed that the cutaneous branches from the intercostal nerves and the dorsothoracic nerve from the brachial plexus could be found entering the dorsal skin, distributed in the skin proper and the panniculus carnosus, respectively. After flap surgery, full spontaneous reinnervation of the skin proper and vessels within the flaps could be achieved at day 180. However, if the stumps of cutaneous branches of the intercostal nerves were damaged, the nerve density in the skin proper underwent a 2/3 decline. The panniculus carnosus in the cranial part had a much better reinnervation than that in the caudal part. The CTMr test showed that the flap could regain most of its sensate and motor activity. Our study shows that strong spontaneous reinnervation could be expected after flap surgery. The pattern of the original nerve distribution in both the recipient and donor sites may have a big impact on the reinnervation of the flap.

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“…Owing to advances in microsurgical techniques, sensory nerve coaptation during autologous breast reconstruction is now possible. This improves the recovery of sensation in the reconstructed breast (Beugels et al, ). Since this is associated with improved QoL (Cornelissen et al, ), preservation or recovery of sensation in the reconstructed breast and the nipple‐areola complex (NAC) is becoming increasingly important.…”

Section: Introductionmentioning

confidence: 99%

Intercostal nerve block of the anterior cutaneous branches and the sensibility of the female breast

et al. 2019

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Introduction Better sensation in the reconstructed breast improves the quality of life. Sensory nerve coaptation is a valuable addition to autologous breast reconstruction. There are few publications concerning the sensory nerves of the breast and the nipple‐areola complex and reports are contradictory, so it is unknown which nerve is best suited as a recipient for coaptation. The current study serves as a proof of concept. Materials and Methods The areas innervated by the anterior cutaneous branches (ACBs) of the intercostal nerves (ICNs) were studied on two separate occasions in two healthy women. First, the ACBs of ICNs 2–5 were individually blocked using ultrasound. Next, the ACBs of all levels were blocked simultaneously. Sensation was measured using Semmes‐Weinstein monofilaments. The numbed areas corresponding to the ICNs were drawn in a raster of 2 × 2 cm. Results The largest area was supplied by the ACB of the 4th ICN, located in the upper (UIQ) and the lower (LIQ) inner quadrants of the breast. The 2nd‐largest area was supplied by the ACB of the 3rd ICN. Blockage of ACBs 2–5 affected sensation in the nipple and the areola. Conclusions Blockage of all levels 2–5 partially affected sensation in the nipple‐areola complex, suggesting innervation by a nerve plexus consisting of both ACBs and lateral cutaneous branches (LCBs). ACB4 supplied the largest area of the breast in the UIQ and LIQ and could be best suited for sensory nerve coaptation to optimize sensation in the autologously reconstructed breast.

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Sensory Recovery of the Breast following Innervated and Noninnervated DIEP Flap Breast Reconstruction

Cited by 56 publications

References 29 publications

Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation

Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation

Quantification of axonal ingrowth and functional recovery in a myocutaneous flap model in rats with strong clinical implications

Intercostal nerve block of the anterior cutaneous branches and the sensibility of the female breast

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