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Neurotization of the nipple-areolar complex after implant-based reconstruction: evaluation of sensation recovery
Isis Scomacao
Cagri Cakmakoglu
Rebecca Knackstedt
Risal Djohan
Cleveland Clinic
2019-02-15
Presenter: Isis Scomacao
Affidavit:
Steven Bernard
Director Name: Steven Bernard
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose; To determine the sensation recovery of the breast after nipple sparing mastectomy and implant-based breast reconstruction associated with neurotization of the nipple areolar complex (NAC).
Methods: We performed a retrospective review of all patients that underwent NSM with implant-based reconstruction and nipple neurotization. Neurotization was performed using a nerve allograft in combination with nerve connector. The sensory recovery process was objectively monitored using a pressure sensory device (static and dynamic test).
Results: Ten patients underwent NAC neurotization and nine (15 breasts) were monitored for sensation recovery. Of the nine patients, eight had bilateral reconstruction and six had bilateral nNipple_neuroeurotization. Three patients underwent tissue expander placement and six direct to implant. Mean age, BMI and specimen weight were 38.12 years old, 23.66kg/m2, 381.04g, respectively. The majority of reconstructions (11) were due to prophylactic mastectomy. For sensory measurement, the nipple had a mean threshold of 67.33±34.48g/nm2. The upper inner (29±26.75 g/nm2) and upper outer (46.82±32.72 g/nm2) NAC quadrants demonstrated better scores during moving test as compared to static test. Mean time between the test and surgery was 5.66±2.02months, and mean time between the second test (3 breasts) and surgery was 8.94±2.06months. Thresholds improvement were documented after the second test for all NAC areas evaluated.
Conclusion: There is a tendency of sensation restoration of the nipple-areolar complex after implant-based reconstruction with neurotization. Providing neurotized breast reconstruction with a nerve graft and conduits is fast, safe and reproducible. More long-term studies are needed to evaluate the timing of sensory recovery utilizing this approach.
