Abstract
Background Breast anesthesia and hypoesthesia occur commonly after mastectomy and negatively
impact quality of life. Neurotization during deep inferior epigastric perforator (DIEP)
breast reconstruction offers enhanced sensory recovery. However, access to neurotization
for DIEP reconstruction patients has not been evaluated.
Methods This retrospective study included patients who underwent DIEP breast reconstruction
between January 2021 and July 2022 at a tertiary-care, academic institution. Demographics,
outcomes, insurance type, and Area Deprivation Index (ADI) were compared using two-sample
t-test or chi-square analysis.
Results Of the 124 patients who met criteria, 41% had neurotization of their DIEP flaps.
There was no difference in history of tobacco use (29% vs 33%), diabetes (14% vs 9.6%),
operative time (9.43 vs 9.73 h), length of hospital stay (3 d vs 3 d), hospital readmission
(9.8% vs 6.8%), or reoperation (12% vs 12%) between patients with and without neurotization.
However, access to neurotization differed significantly by patient health insurance
type. Patients who received neurotization had a lower median ADI percentile of 40.0,
indicating higher socioeconomic advantage compared with patients who did not receive
neurotization at 59.0 (p = 0.01).
Conclusion Access to neurotization differed significantly by patient health insurance and by
ADI percentile. Expanding insurance coverage to cover neurotization is needed to increase
equitable access and enhance quality of life for patients who come from disadvantaged
communities. Our institution's process for preauthorization is outlined to enhance
likelihood of insurance approval for neurotization.
Keywords
breast reconstruction - deep inferior epigastric perforator - DIEP - autologous reconstruction
