Breast skin tends to be tough after a skin-sparing mastectomy. Some sensation may return over time on its own. However, when surgeons include a sensory nerve with the rest of a flap in natural tissue reconstruction can increase the amount of sensation that returns. Abdominal, thigh, and back flaps have nerves that can be identified and connected with nerve allografts to nerves in the area of the reconstructed breast.
Types of Restoring Breast Sensation in Flap Reconstruction Procedures
In some cases, nerves can be directly stitched together. 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 natural tissue flap is elevated in the usual way
- The flap is transferred to the chest wall and blood vessels in the flap are connected to blood vessels in the chest wall
- Nerves from the flap are connected to nerves in the chest using microsurgical techniques
- The nerves will re-sprout in the months following surgery, to potentially 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.