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Nerve Reconstruction in Alloplastic Breast Reconstruction: Expanding the Indications for Breast Reinnervation
Elizabeth A Moroni, MD MHA, Janina Keuper, MD, Zhazira A Irgebay, MD, Casey Zhang, BS, Elizabeth A Bailey, MD MS, Andrea Moreira, MD
University of Pittsburgh Medical Center
2024-02-01
Presenter: Elizabeth Moroni
Affidavit:
I certify the work on this project represents the original work of the resident.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
Loss of sensation after mastectomy can be devastating for patients' quality of life, and even a risk for injury. Prior studies have shown successful reinnervation in autologous breast reconstruction, but this has not been widely studied in implant-based reconstruction, which is more challenging due to the frequent absence of a distal nerve stump target for reinnervation.
Methods
Our group began performing nerve reconstruction in conjunction with breast reconstruction following mastectomy in April 2021. From April 2021-May 2022, all patients who underwent nerve reconstruction with implant-based breast reconstruction were followed postoperatively with the Semes Weinstein monofilament testing as well as the BREAST-Q Sensation Module.
Results
Sixty-five patients were included in the analysis, representing 113 breasts. Fifty-eight of these patients (106 breasts) were nipple-sparing mastectomies. Most patients (n=34) underwent Direct-to-Implant (DTI) reconstruction, while 24 underwent staged alloplastic reconstruction with a tissue expander and 8 underwent autologous reconstruction. Breast resection volume ranged from 122 to 1358g, with mean intercostal nerve dissection 5.2cm (range 0-16cm). On average, a 440cc implant was used for DTI reconstruction (range 210-755cc); if a tissue expander was placed, on-table fill averaged 400cc (range 250-600cc). Using the BREAST-Q sensation module and Semes Weinstein monofilament testing, we observed improved sensation over time, with no abnormal sensation or pain.
Conclusions
While more validated tools are necessary to assess the overall quantitative return of breast sensation after nerve reconstruction, our data suggests positive impact of breast sensation on patient quality of life which increases with time from mastectomy.
