A Prospective Study Comparing Breast Sensation In Neurotized And Non-neurotized Autologous Free Flap Reconstructions Using Electronic Pressure Sensory Gradients
Michael G. Tecce, DO, Jessica Cunning, BA, Shelby L. Nathan, MD, Cutler Whitely, BA, Arturo J. Rios-Diaz, MD, Robyn Broach, PhD, Joseph M. Serletti, MD.
University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE:
Restoration of breast sensation following autologous breast reconstruction (ABR) is integral to the reconstructive paradigm for breast cancer patients. We sought to quantify the impact of neurotization in ABR on sensation and quality of life (QoL).
METHODS:
A patient-blinded prospective study was undertaken for patients undergoing ABR. Patients were assigned to neurotized (NF) group or non-NF group. Using the Pressure-Specified Sensory Device™ to quantify sensation (range:0-100, 100=lowest sensation), mastectomy and flap skin were tested in 4 poles at a minimum of 12-months postoperatively. Kruskal-Wallis tests were used to compare sensation and Breast-Q QoL scores between cohorts at the flap-level.
RESULTS:
One-hundred and fifty-five flaps (49.7% neurotized) were tested. Patients tended to be 53 years-old (IQR 46-61), White (82.2%), non-obese (BMI<30: 57.3%), have TRAM flaps (79.7%). NF demonstrated lower pressure sensation in the superior (66.2 [33.5-96.4] vs 83.2 [51.3-100];p=0.03). Sensation was decreased for patients who underwent radiation therapy (p>0.05) irrespective of neurotization. Of the flaps with minimal sensation (scores>90), lateral mastectomy and flap sensation were significantly less for non-innervated TRAM flaps than non-innervated DIEP flaps (p=0.03 and p=0.03, respectively); no flap-type difference existed amongst innervated flaps (p>0.05). The NF exhibited greater QoL compared to the non-NF in 3/11 domains (p<0.05).
CONCLUSION:
Neurotization during ABR appears to increase sensibility in only one of four quadrants, whereas radiation impairs sensation regardless of innervation status. QoL was higher in the innervation cohort. Further analysis inclusive of change over time is needed as the study progresses.
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