Using Bionics to Restore Sensation to Reconstructed Breasts

Lindau, Stacy Tessler; Bensmaı̈a, Sliman J.

doi:10.3389/fnbot.2020.00024

Cited by 12 publications

(8 citation statements)

References 48 publications

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“…[40][41][42][43] In recent years, concern for sensory outcomes after breast surgery has grown among patients, surgeons, and researchers. [44][45][46][47] Nevertheless, longterm results often remain suboptimal, especially after more extensive surgery. Breast augmentation induces sensory deficits of the nipple and the breast skin in 5 and 10 percent of cases, respectively 29 ; mastopexy affects sensitivity of the nipple in 6 percent of cases 48 ; and breast reduction affects sensitivity in approximately 8 to 14 percent of cases.…”

Section: (61)mentioning

confidence: 99%

Innervation of the Female Breast and Nipple: A Systematic Review and Meta-Analysis of Anatomical Dissection Studies

Smeele

Bijkerk

Kuijk

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Primary cadaveric studies were reviewed to give a contemporary overview of what is known about innervation of the female breast and nipple/nipple-areola complex. Methods: The authors performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses–compliant systematic review and meta-analysis. The authors searched four electronic databases for studies investigating which nerve branches supply the female breast and nipple/nipple-areola complex or describing the trajectory and other anatomical features of these nerves. Inclusion criteria for meta-analysis were at least five studies of known sample size and with numerical observed values. Pooled prevalence estimates of nerve branches supplying the nipple/nipple-areola complex were calculated using random-effects meta-analyses; the remaining results were structured using qualitative synthesis. Risk of bias within individual studies was assessed with the Anatomical Quality Assurance checklist. Results: Of 3653 studies identified, 19 were eligible for qualitative synthesis and seven for meta-analysis. The breast skin is innervated by anterior cutaneous branches and lateral cutaneous branches of the second through sixth and the nipple/nipple-areola complex primarily by anterior cutaneous branches and lateral cutaneous branches of the third through fifth intercostal nerves. The anterior cutaneous branch and lateral cutaneous branch of the fourth intercostal nerve supply the largest surface area of the breast skin and nipple/nipple-areola complex. The lateral cutaneous branch of the fourth intercostal nerve is the most consistent contributory nerve to the nipple/nipple-areola complex (pooled prevalence, 89.0 percent; 95 percent CI, 0.80 to 0.94). Conclusions: The anterior cutaneous branch and lateral cutaneous branch of the fourth intercostal nerve are the most important nerves to spare or repair during reconstructive and cosmetic breast surgery. Future studies are required to elicit the course of dominant nerves through the breast tissue.

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Section: (61)mentioning

confidence: 99%

Innervation of the Female Breast and Nipple: A Systematic Review and Meta-Analysis of Anatomical Dissection Studies

Smeele

Bijkerk

Kuijk

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…4 El complejo areola pezón (CAP) tiene un papel destacado dentro de la estética mamaria, se encuentra en el centro de las subunidades estéticas y tiene relevancia simbólica, psicológica y estética. 5 La pérdida de proyección del pezón es una queja recurrente entre las pacientes sometidas a reconstrucción mamaria. En el caso de la MPPP esta pérdida de proyección es debida a la resección del tejido eréctil del pezón, lo que le otorga una apariencia plana y poco natural.…”

Section: Mejoría En La Proyección Del Pezón Con La Aplicación De áCid...unclassified

Mejoría en la proyección del pezón con la aplicación de ácido hialurónico en reconstrucción mamaria tras mastectomía preservadora de piel y pezón

Cruz-Zermeño¹,

Telich-Tarriba²

2022

Cirugía Plástica

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“…10 Nerve coaptation is one of several innovations surgeons have proposed for restoring sensory feedback. 11,12 The technique involves connecting a donor nerve in the territory of the reconstruction flap to a transected recipient nerve in the chest, and is thought to improve sensory recovery by facilitating axonal regeneration. The concept of sensate free flaps dates to the 1970s, when their benefit was first explored in extremity [13][14][15] and head and neck reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Learning Sensory Nerve Coaptation in Free Flap Breast Reconstruction

Smeele

Beugels

Kuijk

et al. 2023

J Reconstr Microsurg

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Background The aims of this study were to assess whether sensory nerve coaptation in free flap breast reconstruction is subject to learning, and to elucidate challenges of this technique. Methods In this single-center retrospective cohort study, we reviewed consecutive free flap breast reconstructions performed between March 2015 and August 2018. Data were extracted from medical records, and missing values imputed. We assessed learning by exploring associations between case number and probability of successful nerve coaptation using a multivariable mixed-effects model. Sensitivity analysis was performed in a subgroup of cases with evidence of attempted coaptation. Recorded reasons for failed coaptation attempts were grouped into thematic categories. Multivariable mixed-effects models were used to examine associations between case number and postoperative mechanical detection threshold. Results Nerve coaptation was completed in 250 of 564 (44%) included breast reconstructions. Success rates varied considerably between surgeons (range 21-78%). In the total sample, the adjusted odds of successful nerve coaptation increased 1.03-fold for every unit increase in case number (95% confidence interval 1.01 – 1.05, p < .05), but sensitivity analysis refuted this apparent learning effect (adjusted odds ratio 1.00, 95% confidence interval 1.00 – 1.01, p = .34). The most frequently recorded reasons for failed nerve coaptation attempts were inability to locate a donor or recipient nerve. Postoperative mechanical detection thresholds showed a negligible, positive association with case number (estimate 0.00, 95% confidence interval 0.00 – 0.01, p < .05). Conclusions This study does not provide evidence in support of a learning process for nerve coaptation in free flap breast reconstruction. Nevertheless, the identified technical challenges suggest that surgeons may benefit from training visual search skills, familiarizing with relevant anatomy, and practicing techniques for achieving tensionless coaptation. This study complements prior studies exploring therapeutic benefit of nerve coaptation by addressing technical feasibility.

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Using Bionics to Restore Sensation to Reconstructed Breasts

Cited by 12 publications

References 48 publications

Innervation of the Female Breast and Nipple: A Systematic Review and Meta-Analysis of Anatomical Dissection Studies

Innervation of the Female Breast and Nipple: A Systematic Review and Meta-Analysis of Anatomical Dissection Studies

Mejoría en la proyección del pezón con la aplicación de ácido hialurónico en reconstrucción mamaria tras mastectomía preservadora de piel y pezón

Learning Sensory Nerve Coaptation in Free Flap Breast Reconstruction

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