Breast Reinnervation following Mastectomy: Demonstration of Proof of Principle
Gloria R Sue, MD; Dung H Nguyen, MD, PharmD
Stanford University, Stanford, CA
Preservation of nipple and mastectomy skin sensation following mastectomy is associated with improved patient quality of life. We propose that the intercostal nerves to the breast can be used as a donor nerve for neurotization of the nipple, mastectomy skin, and/or of a reconstructed flap to the breast.
Materials and Methods
Patients undergoing mastectomy who desired nipple or skin reinnervation were included in this study. The donor nerves used for neurotization were the medial or lateral 3-5th intercostal nerves. The donor nerves were dissected out to length and neurorrhaphy was performed to the base of the nipple, mastectomy skin, or the reconstructed flap to the breast. Sensation was assessed post-operatively using Semmes-Weinstein monofilament testing.
A total of 5 patients underwent mastectomy and subsequent reinnervation. Three patients underwent mastectomy for gender dysphoria and the neurotization of the base of the nipple. One patient underwent mastectomy with autologous reconstruction and neurotization of the flap, with the abdominal intercostal nerve as the recipient nerve. One patient underwent mastectomy with implant-based reconstruction and neurotization of the overlying mastectomy skin. Patients were followed up out to 6 months post-operatively and were all noted to have progressive improvement of sensation from baseline immediately following surgery.
Breast reinnervation provides a significant increase in sensory recovery for patients undergoing mastectomy. This may in turn lead to an increase in quality of life. Challenges in breast reinnervation include a potentially tedious dissection and a limited length of the donor nerve which may preclude reinnervation in patients undergoing immediate reconstruction following mastectomy. Future studies include assessment of nerve grafts or scaffolds in facilitating reinnervation of post-mastectomy breasts.
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