Restoring Sensation

BREAST AND NIPPLE SENSATION AFTER MASTECTOMY

During a mastectomy, the nerves that supply sensation to the breast and nipple are resected along with the breast tissue. As a result, patients usually report numbness in their remaining breast skin. When patients undergo breast reconstruction with implants, numbness is expected because the implant is a barrier that blocks nerves from growing through it to restore sensation to the skin. When patients undergo autologous breast reconstruction with a flap composed of their own skin and tissue, however, the nerves and blood vessels naturally grow into the patient’s flap to create a soft, warm, and living breast.

Nerve sensation can be divided into four types: deep pressure, light touch, pain, and temperature. Each type of sensation returns at a different rate, with deep pressure returning more quickly and temperature returning more slowly. Overall, however, nerves growth is quite slow. Research on nerve growth has shown that nerves regenerate at an average rate of 1 mm/day. Thus, it can take months to years for regenerating nerves to reach the skin, and the quality of sensation is variable.

Restoring Sensation for Breast Reconstruction Patients

Since nerve growth is slow, gradual, and unpredictable, many reconstructive surgeons do not consider it a priority during breast reconstruction. It takes extra time to reconnect nerves, and full return of sensation is not guaranteed. Despite this, however, we still feel that it is worthwhile to do our best to restore a woman's breast as much as possible to its original sensory state. Multiple studies have shown that making the effort to repair nerves can result in more rapid return of sensation and improved sensation. While many outcomes may be modest, a few of our patients who have undergone nipple-sparing mastectomies with autologous tissue reconstruction have claimed that they have near-normal postoperative sensation and even erectile function of their nipple.

Dr. Chen has been reconnecting nerves in breast reconstruction for almost 10 years. Over time, her approach toward nerve repair in breast reconstruction patients has changed and evolved. Recent advances in nerve reconstruction have made it easier to repair nerves to restore sensation. Innovative new techniques that use neural tubes and nerve grafts make it possible to reconnect nerves both in patients who are undergoing mastectomy with immediate breast reconstruction and in patients who previously had implants and are switching to autologous tissue reconstruction. As a pioneer in the field, Dr. Chen was recently invited to participate in a roundtable and lab event to teach and develop best techniques for breast reinnervation after mastectomy. In her practice, Dr. Chen works to establish nerve repair during autologous tissue breast reconstruction as the new standard of care for women with breast cancer.