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Novel Approach for Targeted Breast Re-Innervation after Mastectomy in Implant-Based Reconstruction
Rebecca Knackstedt MD PhD; Demetrius Coombs MD; Cagri Cakmakoglu MD; Risal Djohan MD
Cleveland Clinic
2018-02-12
Presenter: Rebecca Knackstedt
Affidavit:
I agree
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background
The concept of providing innervation post-mastectomy as part of autologous reconstruction is not novel. However, this technique is yet to be widely adopted, perhaps to the difficulty of technique. Also, there have been no reports on techniques to provide innervation after mastectomy in the context of implant-based reconstruction. Herein, we present our novel approach to provide innervation to mastectomy skin flaps during implant-based reconstruction.
Methods
After completion of mastectomy, the lateral intercostals of the 4th or 5th rib are isolated and prepared under the microscope. The distal end of the intercostal nerve is loosely connected to the nerve graft with a 9-0 nylon suture and the connection is supported with a nerve conduit r sutured in place and stabilized with Tisseel glue. The tissue expander is placed, the nerve repair is passed through the AlloDerm and anchored to the underside of the nipple areolar complex.
Results
We have performed this technique on 4 patients. We have found the donor nerve location to be predictable, with adequate size and location in the surgical field. We have found this approach to be easy and reproducible with a small learning curve.
Conclusion
We plan on monitoring the return of breast sensation in these patients as we continue to recruit more patients. We also plan on determining the impact that enabling a potentially faster, more reproducible breast innervation has on breast-related quality of life. There are many unaswered questions that remain to determine the most efficactious and reproducible way to provide breast re-innervation.
