Breast Flap Neurotization After Autologous Free Flap Breast Reconstruction: A Prospective Trial
Abhishek A. Desai, MD
1 Jessica Cunning, MD 1 ; Adrienne Christopher, MD 1 ; Shelby L. Nathan, MD 1 ; Arturo J. Rios Diaz, MD 1 ; Martin P.
Morris, MBE 1 ; Ankoor A. Talwar, MBA 1 ; Phoebe B. McAuliffe, BA 1 ; Robyn B. Broach, PhD 1 ; Joseph M. Serletti , MD 1 ; Michael G. Tecce , DO 1
1 Division of Plastic Surgery, Department of Surgery, University of Pennsylvania , Philadelphia, PA, USA

 

Purpose

Restoration of breast sensation is an important factor to consider
following autologous breast reconstruction ( Flap neurotization may
result in improved sensation after ABR, but current literature regarding
both patient reported outcomes and quantitative sensation after
neurotization is inadequate and heterogenous We present a prospective
trial investigating the long term outcomes of flap neurotization regarding
breast sensation

Methods
•A patient blinded prospective study was performed
•115 patients assigned to neurotized (NF) group or non NF groups
•65 neurotized patients (n=113 flaps)
•50 non neurotized patients (n=90 flaps)
•Patients were prospectively evaluated for breast sensation and
quality of life 1 5 years after ABR
•PSSD: pressure specified sensation testing at 9 locations on
the breast using the AcroVal PSSD
•BREAST Q: validated patient reported questionnaire
•Sensation questionnaire: a sensation specific PRO
•Continuous variables were compared using independent t tests.
Categorical variables were compared using chi squared analyses.

 

FIG 1 Sensation was tested on both mastectomy and flap skin areas, which were each
divided into quadrants One point static and one point moving pressures were measured for
mastectomy skin, while only one point static pressure was measured for flap skin

 

Results

Neurotization significantly improved both patient reported psychological wellbeing and
sexual wellbeing after free flap breast reconstruction 0 02 < 0 04 While there was a small
difference in quantitative sensation between neurotized and non neurotized patients at 1 year
after ABR, the improved protective sensation afforded by neurotization was significantly
more pronounced among the 2 5 year subgroup, with improved sensation at 4 of 9 testing
locations on the breast as compared to non neurotized patients 0 011 < 0 039

TABLE 2 Patient reported outcome measures for each BREAST Q domain
Neurotized patients reported significantly greater satisfaction with both
psychological and sexual wellbeing as compared to non neurotized patients

 

FIG. 2
Neurotized patients had
significantly lower pressure
specified sensory thresholds for
both one point moving and one
point static stimulus at the
mastectomy inferior site when
compared across all follow up
windows (p<0.02).

 

FIG. 3
The improved sensation
afforded by neurotization was more
significant among the 2 5 year
subgroup, among whom neurotized
patients had significantly lower
PSSD thresholds at four testing
sites, mastectomy superior,
mastectomy lateral, flap lateral, and
flap center (0.011<p<

 

Conclusions

Breast sensation affects the daily lives of breast reconstruction patients and is an important
long term outcome to consider following ABR Neurotization is associated with improved
protective sensation as well as improved patient reported outcomes such as improved
psychological and sexual wellbeing in the long term after ABR