Introduction

• Breast reconstruction restores form and function after mastectomy, but sensory loss is common
• Up to 80% of patients experience sensory loss
• Breast sensation impacts body image, sexual function, psychological well-being, quality of life, and satisfaction
• Surgical strategies to improve sensation include nipple/flap innervation and nerve optimization (preservation, coaptation, grafting)
• Limited data exist on which sensation types matter most to patients and how sensation influences decision-making

Objective

Assess patient priorities regarding breast sensation, its perceived importance in decision-making, awareness of nerve optimization, and associations with postoperative satisfaction

Methods

• Online survey distributed via breast cancer communities (Breast of Us, Tower Collective, DIEP C Foundation Facebook group), April 2024–July 2025
• Inclusion: Female, ≥18 years, history of breast reconstruction for breast cancer
• Primary outcomes:
  • BREAST-Q Satisfaction with Breasts (0–100)
  • BREAST-Q Satisfaction with Information (0–100)
• Statistical analysis: Descriptive statistics, independent t-tests, multivariable linear regression (adjusted for age, cancer stage, income, mastectomy type, and time since reconstruction)

Patient Demographics

• N = 235
• Age: 55 ± 11.5 years
• Time since reconstruction: 5 years (IQR: 2–11)
• Race: White (90%), Non-White (10%)
• Reconstruction type: Implant (49%), Free flap (50%), Pedicled (10%)
• Cancer stage: 0/DCIS (18%), Stage I (34%), Stage II (29%), Stage III (15%), Stage IV (1%)

Consideration of Nerve Optimization

• Aware and considered: 16%
• Aware, did not consider: 5%
• Not aware, would have considered: 54%
• Not aware, would not have considered: 16%
• Unsure: 9%

Discussion

• Importance of sensation is heterogeneous: 26% rate it moderately/extremely important, while 24% rate it not important
• Sensory priorities shift from pre- to post-reconstruction
• Most patients were unaware of nerve optimization, yet many would have considered it if informed
• Awareness and consideration are associated with higher satisfaction and decision confidence

Clinical Implications

Preoperative counseling should:

1. Ask which sensations matter most to each patient
2. Explain types of sensation (tactile, erogenous, thermal/protective, pain/pruritus)
3. Discuss nerve optimization options
4. Set realistic expectations and recovery timelines

Conclusions

• Breast sensation is a critical but under-addressed component of reconstruction
• Awareness of nerve optimization is associated with higher postoperative satisfaction
• Improving preoperative education represents a modifiable opportunity to enhance patient outcomes