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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2024; 09(02): e102-e108
DOI: 10.1055/a-2222-9031
Original Article

Bridging the Gap: A Pilot Study on the Efficacy of Nerve Allografts in Autologous Breast Reconstruction

Marcos Lu Wang
1   Division of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital—Cornell and Columbia, New York
,
Hao Huang
1   Division of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital—Cornell and Columbia, New York
,
Ashley Zhang
2   Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, New York
,
Angela Ellison
2   Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, New York
,
Grant G. Black
2   Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, New York
,
David M. Otterburn
2   Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, New York
› Author Affiliations Funding D.M.O. receives research support from AxoGen Inc. (Alachua, FL) to evaluate return of sensation after autologous reconstruction. All other authors have no personal financial disclosures or commercial associations.
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Abstract

Background Breast anesthesia is commonly reported after mastectomy and reconstruction. During deep inferior epigastric perforator (DIEP) flap reconstruction, we coapt at least one of the T10 to T12 thoracoabdominal nerves within the flap to the anterior cutaneous branch of the third intercostal nerve using a nerve allograft. We aim to evaluate the efficacy of nerve grafting in improving sensory recovery following neurotized DIEP flap reconstruction.

Methods Thirty patients (54 breasts) underwent immediate neurotized DIEP flap reconstruction using nerve grafts. Sensitivity evaluation was performed in nine breast regions. For each patient, sensation was compared between two time points: 3 to 6 months postoperatively versus 12 to 24 months postoperatively. The reconstructive BREAST-Q was used to survey patients' satisfaction of their breasts, physical well-being, psychosocial well-being, and sexual well-being.

Results At 3 to 6 months postoperatively, patients had a mean sensitivity measurement of 52.1 g/mm2. At 12 to 24 months postoperatively, patients had a mean sensitivity measurement of 40.3 g/mm2. There was a significant decrease in the mean cutaneous threshold required for patients to perceive sensation between the two time points (–29.1%, p = 0.041). On the reconstructive BREAST-Q, patients scored significantly higher in breast satisfaction (56.7/100 vs. 75.1/100, 32.5%, p = 0.032) and physical well-being (66.0/100 vs. 85.5/100, 20.2%, p = 0.022) between the two time points.

Conclusion Patients who undergo nerve graft-based DIEP flap reconstruction can expect significant improvements in sensation to pressure over time. This improvement found on sensory testing correlates with significant improvement in patients' BREAST-Q scores.

Keywords

breast reconstruction - nerve graft - DIEP flap


Publication History

Received: 11 July 2022

Accepted: 20 September 2023

Accepted Manuscript online:
05 December 2023

Article published online:
02 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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