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J Reconstr Microsurg 2025; 41(05): 398-404
DOI: 10.1055/a-2404-1924
Original Article

Accessibility of Neurotization in Deep Inferior Epigastric Perforator Flap Reconstruction: Inequities and Implications for Preauthorization

Rachel E. Schafer 
1   Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
,
Joseph D. Quick
1   Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
,
Madeleine M. Blazel
1   Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
,
Priya Shukla
1   Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
,
Shannon S. Wu
1   Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
,
Raffi Gurunian
3   Department of Plastic Surgery, Cleveland Clinic, Abu Dhabi
,
Steven Bernard
2   Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Sarah N. Bishop
2   Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Graham Schwarz
2   Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Risal Djohan
2   Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations
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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

Funding

Dr. Risal Djohan is a member for Axogen speakers and advisory group. None of the other authors has a financial interest, commercial association, or disclosure regarding any of the companies, organizations, products, services, devices, or drugs that may be mentioned in this manuscript. There are no funding sources to disclose, including NIH, Wellcome Trust, HHMI, or other.


Presented at

American Society of Plastic Surgeons Annual Meeting in Austin, TX (10/2023).




Publication History

Received: 31 May 2024

Accepted: 12 August 2024

Accepted Manuscript online:
27 August 2024

Article published online:
20 September 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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