Restoring Breast Sensation in Flap Reconstruction

At a Glance: Nerve repair may help restore sensation to nerves that are cut during a mastectomy using a technique called Resensation®.

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.

Why does mastectomy result in numb breasts

Types of procedures

In rare cases, sensory breast nerves can be repaired by directly stitching them together. This is called direct neurotization. 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 relative ease and minimal additional operative time [2].

Resensation is a surgical technique performed during breast reconstruction that provides plastic surgeons an option to reconnect nerves cut during the mastectomy using nerve allograft. A nerve allograft 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.

How does Resensation work

Resensation options for autologous flap reconstruction:

  • Immediate reconstruction (at the same time as mastectomy)
  • Delayed-Immediate reconstruction (at the same time as mastectomy, with placement of temporary implant or expander as a placeholder during radiation therapy or other treatments prior to a later flap reconstruction)
  • Delayed reconstruction (months or years after mastectomy)
  • Revision of primary implant reconstruction to flap reconstruction (months or years after mastectomy)
  • Aesthetic flat closure (at the same time as mastectomy)

Surgical candidacy will vary based on past medical/surgical history, type of breast reconstruction planned and timing/type of mastectomy.

Procedure details:

  • The mastectomy is performed by a breast surgeon, either at a previous time or immediately.
  • A plastic surgeon prepares the flap donor site, which is the area where the skin, fat, blood vessels and nerves are taken from and used to reconstruct the breast. This process involves elevating the flap and identifying the blood vessels and nerves using microsurgical technique.
  • The recipient site is prepared by the plastic surgeon, which involves identifying the blood vessels and nerves in the chest wall using microsurgical technique.
  • The flap with blood vessels and nerves are transferred to the chest.
  • An operating microscope or loupe magnification is used to connect the flap blood vessels to blood vessels in the chest.
  • One side of the nerve allograft is connected to a nerve in the flap. The other side of the nerve allograft is connected to a nerve in the chest using microsurgical suturing techniques to complete the Resensation portion of the procedure.
  • Final breast reconstruction adjustments are made, and the donor site is closed to complete the operation.

Nerves are small, delicate structures. The Resensation procedure requires 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. Resensation 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].

Learn more about Resensation nerve repair at Resensation.com.