Restoring Sensation in Implant Reconstruction

Summary

During a mastectomy, the nerves that supply sensation to the breast and nipple must be cut so that the breast tissue can be removed. This typically results in partial to complete numbness in the chest – impacting the ability to feel touch, temperature and even pain. Loss of sensation can diminish quality of life and put the chest area at risk of local injury [1]. Plastic surgeons who specialize in microsurgery can perform breast nerve repair surgery (also known as breast neurotization) to improve chances of regaining breast sensation.

Nerve repair procedures

In most cases when the mastectomy is complete, the distance between two cut nerves is too wide for direct repair. Recent advances in nerve reconstruction have made it possible to perform breast nerve repair surgery with relatively easily with minimal additional operative time [2].

Specially trained plastic surgeons can reconnect nerves cut during the mastectomy using nerve graft. A nerve graft is processed donated human nerve tissue that acts as a three-dimensional scaffold to bridge the gap between two healing nerves. Over time, the nerve fibers regenerate, becoming a part of the patient’s body. As the nerve fibers grow, they have the potential to restore sensation to the chest.

Breast nerve repair options for implant-based reconstruction:

• Immediate reconstruction (at the same time as nipple-sparing mastectomy, with placement of permanent implant or temporary expander)
• Delayed-Immediate reconstruction (at the same time as nipple-sparing mastectomy, with placement of temporary implant or expander as a placeholder during radiation therapy or other treatments prior to a permanent implant or flap reconstruction)

Surgical candidacy will vary based on past medical/surgical history, type of breast reconstruction planned and timing/type of mastectomy. Collaboration between a plastic surgeon and breast surgeon during mastectomy and reconstruction is ideal.

Procedure details:

• A breast surgeon performs a nipple-sparing mastectomy with nerve identification and careful dissection. As the surgeon removes the breast tissue, a nerve found along the outer edge of the chest is identified and prepared for the plastic surgeon to perform the nerve repair. 
• A plastic surgeon connects one side of the nerve graft to the identified sensory nerve using microsurgical suturing techniques.
• A breast implant and biologic tissue matrix (which reinforces and repairs soft tissue in the area) is placed by the plastic surgeon.
• The plastic surgeon connects the other side of the nerve graft to the target sensory nerve or nerve area in the nipple areola region using microsurgical suturing techniques to complete the breast neurotization portion of the procedure.
• Final breast reconstruction adjustments are made by the plastic surgeon to complete the operation.

Nerves are small, delicate structures. Nerve repair procedures require a surgeon with specialized training in blood vessel, nerve, and other intricate structure repair using a microscope or loupe magnification and microsurgical instruments. Restoring sensation to the nipple areola region during immediate nipple-sparing mastectomy with breast reconstruction also requires a breast surgeon experienced in nerve identification and handling. The breast surgeon and plastic surgeon team approach provides patients with the best possible outcome.

Nerves take time to heal and grow, regenerating at a rate of about 1 millimeter per day [3]. Patients typically start to regain sensation several months after the procedure. Feelings/sensation can continue to develop for up to two years [4]. Each patient’s experience is unique, but some report feelings of zaps, zings or tingles as sensation returns.

Risks & Benefits

Breast sensation is different for everyone prior to mastectomy and breast cancer surgery. The level of sensation return will vary for every individual.

Restoring breast sensation can mitigate the risks that come with numbness after mastectomy. Loss of sensation in the breast and chest can be emotionally distressing, impact body image, and increase the risk of injury to the affected area by sharp or hot objects or water, and sun damage. Nerve repair may reduce the risk of post-mastectomy pain. It can also improve proprioception, the body’s innate understanding of its own position in the world and the sense that a person’s body parts belong to them. In a recent study, women reported that regaining sensation helped them recover and move on from their experience with cancer, the mastectomy and the reconstruction process. It also helped them feel more normal and more like their old selves [5].

References

1. https://journals.lww.com/prsgo/fulltext/2016/10000/Thermal_Injury_to_Reconstructed_Breasts_from.8.aspx
2. https://pubmed.ncbi.nlm.nih.gov/36194066/
3. https://www.hindawi.com/journals/bmri/2014/698256/
4. https://journals.lww.com/plasreconsurg/Abstract/2002/05000/Breast_Reconstruction_Using_the_Sensate_Latissimus.18.aspx
5. https://www.resensation.com/wp-content/uploads/2022/07/Axogen_Resensation-numbness-white-paper.pdf