Targeted Muscle Reinnervation following Breast Surgery: A Novel Technique

Abstract

Summary: Post-mastectomy pain syndrome is a prevalent chronic pain condition that affects numerous patients following breast surgery. The mechanism of this pain has been proposed to be neurogenic in nature. As such, we propose a novel surgical method for the prophylactic management of postsurgical breast pain: targeted muscle reinnervation of the breast. This article serves to review the relevant current literature of post-mastectomy pain syndrome and targeted muscle reinnervation, describe our current surgical technique for this operation, and present an initial cohort of patients to undergo this procedure.

Targeted muscle reinnervation in managing post‐amputation related pain: A systematic review and meta‐analysis

“…9 A p-value of ≤0.05 indicated significantly heterogeneous studies. The median and interquartile range were used when the mean and standard deviation were not available (Valerio et al 10 ; TMR and standard treatment groups and O'Brien et al 11 ; standard treatment group). As data were not retrieved from the authors, means and standard deviations they were estimated using the method proposed by Wan et al 12…”

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

“…If nerves are encountered that cannot be used for reinnervation because they are too proximal or distal, or if they have been transected in error at the level of the chest wall, our preference is to perform either targeted muscle reinnervation (TMR) or regenerative peripheral nerve interface reconstruction (RPNI) with the nerve endings to decrease the risk of chronic pain and possibly phantom sensations. 14 , 15 TMR is a technique in which the proximal nerve end is coapted to a small muscle motor branch in close proximity to the nerve stump. 16 RPNI is a technique in which the nerve stump is wrapped in a small muscle cuff.…”

Incidence, risk factors, prevention and treatment of postmastectomy pain syndrome in breast cancer: A multicenter study

“…On the premise of ensuring the complete removal of the focus during the operation, it is recommended to protect the skin, residual breast tissue, lymphoid tissue and nerve tissue as much as possible to avoid damage. A study has shown that complete resection of the injured intercostal nerve can also reduce the occurrence of neuroma and postoperative pain [102].…”