Risk and protective factors affecting sensory recovery after breast reconstruction

Background Although loss of sensation in patients with breast cancer after mastectomy followed by breast reconstruction is an important factor affecting patients’ quality of life, the mechanism of sensory recovery is still unclear. Our study aimed to identify variables that affect sensory recovery, especially pain, in reconstructed breasts.

Methods All patients with breast cancer who underwent mastectomy followed by immediate breast reconstruction, including nipple reconstruction or areolar tattooing, were included in this study. Sensation was evaluated in the nipple as an endpoint of sensation recovery of the whole breast. Patients rated pain severity using a 3-point verbal rating scale (VRS): grade 0, no pain; grade 1, mild to moderate pain; and grade 2, severe pain. The VRS was assessed by a single experienced plastic surgeon.

Results In the univariate analysis, the odds ratio (OR) for sensation recovery was 0.951 for age (P=0.014), 0.803 for body mass index (P=0.001), 0.996 for breast volume before surgery (P=0.001), 0.998 for specimen weight after mastectomy (P=0.040), and 1.066 for the period between mastectomy and sensory assessment (P=0.003). In the multivariate analysis, the variables that showed a significant effect were age (OR, 0.953; P=0.034), the period between mastectomy and sensory assessment (OR, 1.071; P=0.006), and reconstruction using abdominal tissue instead of prosthetic reconstruction (OR, 0.270; P=0.004).

Conclusions Based on our results, it can be inferred that aging has a negative impact on the recovery of sensation, breast sensation improves with time after surgery, and the recovery of sensation is better in prosthetic reconstruction.

Mammoplasty - Sensation - Risk factors

Publication History

Received: 24 June 2020

Accepted: 27 October 2020

Article published online:
20 March 2022

• REFERENCES

• 1 Spear SL, Ganz JC. Immediate postmastectomy reconstruction: TRAM flap transposition techniques. In: Methes SJ, Hentz VR. Plastic surgery: Volume 4: Trunk and lower extremity. 2nd ed. Philadelphia: Saunders; 2006: 835-47
• 2 Beugels J, Cornelissen AJ, Spiegel AJ. et al. Sensory recovery of the breast after innervated and non-innervated autologous breast reconstructions: a systematic review. J Plast Reconstr Aesthet Surg 2017; 70: 1229-41
• 3 Schlenz I, Kuzbari R, Gruber H. et al. The sensitivity of the nipple-areola complex: an anatomic study. Plast Reconstr Surg 2000; 105: 905-9
• 4 Blondeel PN, Demuynck M, Mete D. et al. Sensory nerve repair in perforator flaps for autologous breast reconstruction: sensational or senseless?. Br J Plast Surg 1999; 52: 37-44
• 5 Spiegel AJ, Menn ZK, Eldor L. et al. Breast reinnervation: DIEP neurotization using the third anterior intercostal nerve. Plast Reconstr Surg Glob Open 2013; 1: e72
• 6 Temple CL, Tse R, Bettger-Hahn M. et al. Sensibility following innervated free TRAM flap for breast reconstruction. Plast Reconstr Surg 2006; 117: 2119-27
• 7 Santanelli F, Longo B, Angelini M. et al. Prospective computerized analyses of sensibility in breast reconstruction with non-reinnervated DIEP flap. Plast Reconstr Surg 2011; 127: 1790-5
• 8 Stromps JP, Bozkurt A, Grieb G. et al. Spontaneous reinnervation of deep inferior epigastric perforator flaps after delayed breast reconstruction. J Reconstr Microsurg 2016; 32: 169-77
• 9 Tindholdt TT, Tonseth KA. Spontaneous reinnervation of deep inferior epigastric artery perforator flaps after secondary breast reconstruction. Scand J Plast Reconstr Surg Hand Surg 2008; 42: 28-31
• 10 Magarakis M, Venkat R, Dellon AL. et al. Pilot study of breast sensation after breast reconstruction: evaluating the effects of radiation therapy and perforator flap neurotization on sensory recovery. Microsurgery 2013; 33: 421-31
• 11 Benediktsson KP, Perbeck L, Geigant E. et al. Touch sensibility in the breast after subcutaneous mastectomy and immediate reconstruction with a prosthesis. Br J Plast Surg 1997; 50: 443-09
• 12 Yano K, Hosokawa K, Takagi S. et al. Breast reconstruction using the sensate latissimus dorsi musculocutaneous flap. Plast Reconstr Surg 2002; 109: 1897-902
• 13 Shridharani SM, Magarakis M, Stapleton SM. et al. Breast sensation after breast reconstruction: a systematic review. J Reconstr Microsurg 2010; 26: 303-10
• 14 Lee WY, Kim MJ, Lew DH. et al. Three-dimensional surface imaging is an effective tool for measuring breast volume: a validation study. Arch Plast Surg 2016; 43: 430-07
• 15 Bijkerk E, van Kuijk SMJ, Beugels J. et al. Breast sensibility after mastectomy and implant-based breast reconstruction. Breast Cancer Res Treat 2019; 175: 369-78
• 16 Beugels J, Cornelissen AJ, van Kuijk SM. et al. Sensory recovery of the breast following innervated and noninnervated DIEP flap breast reconstruction. Plast Reconstr Surg 2019; 144: 178e-188e
• 17 Delay E, Jorquera F, Lucas R. et al. Sensitivity of breasts reconstructed with the autologous latissimus dorsi flap. Plast Reconstr Surg 2000; 106: 302-09
• 18 Jensen MP, Castarlenas E, Roy R. et al. The utility and construct validity of four measures of pain intensity: results from a university-based study in Spain. Pain Med 2019; 20: 2411-20
• 19 Mofid MM, Dellon AL, Elias JJ. et al. Quantitation of breast sensibility following reduction mammaplasty: a comparison of inferior and medial pedicle techniques. Plast Reconstr Surg 2002; 109: 2283-08
• 20 Cornelissen AJ, Beugels J, van Kuijk SM. et al. Sensation of the autologous reconstructed breast improves quality of life: a pilot study. Breast Cancer Res Treat 2018; 167: 687-95
• 21 Khan A, Zhang J, Sollazzo V. et al. Sensory change of the reconstructed breast envelope after skin-sparing mastectomy. Eur J Surg Oncol 2016; 42: 973-09