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Sensory Preservation after Gender-Affirming Mastectomy: Prospective Matched Case Control Study of Quantitative and Qualitative Sensory Outcomes of Targeted Nipple Areola Complex Reinnervation (TNR)
Katya Remy, MD
Katherine H. Carruthers, MD
Eleanor G. Tomczyk, MD
Jonathan M. Winograd, MD
William G. Austen Jr., MD
Lisa Gfrerer, MD PhD
Ian L. Valerio, MD
Massachusetts General Hospital
2024-02-01
Presenter: Katya Remy
Affidavit:
Ian L. Valerio, MD
Director Name: Ian Valerio
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Loss of sensation is common following double incision gender-affirming mastectomy (GAM) with free nipple grafting. Nerve preservation and reconstruction using targeted NAC reinnervation (TNR) has the potential to restore sensation. This study analyzes the quantitative and qualitative sensory outcomes of GAM with TNR.
Methods: 25 subjects (GAM with TNR) were compared to 25 matched controls (GAM without TNR). Monofilament testing and patient reported outcomes were completed preoperatively, and at 1, 3, 6, 9 and 12 months postoperatively. Vibration, two-point discrimination, pinprick, temperature detection and pressure pain were completed preoperatively and at 12 months postoperatively.
Results: Monofilament values were better in subjects than controls starting at 1 month postoperatively (p<0.05) and became comparable to baseline within 3 months (p>0.05). At 12 months postoperatively, all sensory functions were significantly better in subjects than controls (p<0.05). In subjects, while monofilament values, two-point discrimination and vibration were improved as compared to baseline (p<0.05) pinprick, temperature and pressure pain returned to preoperative values (p>0.05). Subjects reported better nipple and chest light touch, chest pressure and erogenous sensation starting at 1 month postoperatively and temperature sensation starting at 9 months (p<0.05). At 12 months, 82% of subjects reported either 4 or 5 on a 5-point Likert scale for nipple sensation as compared to 4% of controls (p<0.05). Nipple hypersensitivity was higher in subjects than controls until 3 months (p<0.05).
Conclusion: TNR is associated with improved preservation of quantitative and qualitative sensory function compared to controls. Patients should be counseled about the risk of transient NAC hypersensitivity.
