Should Nerve Coaptation Be Routine? Breast Sensation Following Mastectomy +/- Reconstruction
Peter F. Koltz, M.D., Jason M. Weissler, M.D., Martin J. Carney, B.S., Isabella Guajardo, B.S., Stephen J. Kovach, M.D., Alexander Au, M.D., Joshua Fosnot, M.D., Suhail K. Kanchwala, M.D., Joseph M. Serletti, M.D., Liza C. Wu, M.D..
University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: Restoration of breast sensation following breast reconstruction is an evolving part of the reconstructive paradigm. Although spontaneous recovery of sensation has been reported following mastectomy, surgeons are advocating for innervated reconstructions using neurotization at the time of autologous reconstruction. In an effort to further elucidate the evidence basis for nerve coaptation, a meta-analysis of the literature was undertaken.
METHODS: A literature review was conducted according to PRISMA guidelines in effort to perform meta-analysis. Relevant studies reporting breast sensibility following mastectomy with or without reconstruction were extracted, pooled, and compared. The primary outcomes of interest were tactile, thermal, 2-point discriminatory, and vibratory sensibility. The effect of nerve coaptation with and without interposition grafting was examined.
RESULTS: The initial search yielded 505 studies, narrowed to 36. Fourteen trials investigating neurotized breast reconstruction have been reported, and all report quantitatively greater sensibility following neurotized breast reconstruction. 4 studies report statistical analysis (n=168), and of these, 56 patients underwent nerve-grafted reconstruction, whereas 86 patients served as controls (no nerve-grafting). Based on results from the relevant studies, nerve coaptation significantly improved breast mound sensation above mastectomy alone, implant reconstruction, and tissue reconstruction without nerve coaptation.
CONCLUSION: Restoring sensation to the reconstructed breast via nerve coaptation is an invaluable adjunctive procedure in breast reconstruction. Based on this systematic review, evidence-based recommendation for nerve coaptation can be offered.
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