Breast skin tends to be numb after a patient has a mastectomy. While sensation may return with time, the extent to which a patient will recover is hard to predict. Surgeons can perform nerve grafting at the time of mastectomy to improve a patient’s chances of regaining breast sensation. A nerve graft from a sensory nerve that comes out of the chest wall can be connected to another sensory nerve in the nipple areola area.
Types of procedures
Nerves can be reconnected in several ways to restore sensation. In some cases, it is possible to stitch them directly to each other. When there is a space between two nerves, a surgeon can use a nerve allograft and nerve connectors to line up and attach the nerves.
- A breast surgeon performs a nipple-and-skin-sparing mastectomy
- A plastic surgeon begins the process of preparing the never grafts during the mastectomy
- Nerve grafts are attached to a sensory nerve on the chest wall
- A plastic surgeon places a breast implant to complete the breast reconstruction
- The nerve graft from the chest wall is connected to a target sensory nerve in the nipple areola region using microsurgical techniques
- The nerves will re-sprout in the months following surgery, which may improve sensation
Risks & Benefits
Procedures that connect nerves to improve sensation can increase both the length and technical difficulty of a reconstructive surgery. Not all patients experience restored sensation.
Most plastic surgeons do not believe that it is necessary to add the step of reconnecting nerves, as many patients get some sensation back over time without it. Careful attention to mastectomy technique further improves the chances that a patient will retain sensation in their reconstructed breast. However, patients tend to be more satisfied if sensation is restored, and restoring sensation may reduce the risk of post-mastectomy pain.