A Look At The Sequential Return Of Breast Sensation After Autologous Breast Reconstruction: Is It Worth The Nerve Graft?
Harrison D. Davis, BS, Theodore E. Habarth-Morales, BS, 1LT, USAR, NRAEMT, Jessica R. Cunning, MD, Shelby L. Nathan, MD, Robyn B. Broach, PhD, Joseph M. Serletti, MD.
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: Flap neurotization (FN) is increasingly being used in autologous breast reconstruction (ABR) to improve recovery of breast sensation. However, the timing of when sensation returns remains unknown. This study aimed to determine if neurotization accelerates time to sensation.
METHODS: This was a prospective study in which patients underwent either FN+ or FN- ABR. Each breast mound was divided into 9 regions and evaluated for sensation at 6 weeks, 3 weeks, 6 months, and 12 months postoperatively using the AcroVal pressure-specified sensation device. The means of sensation at each time point were compared with independent t-tests by region and by whole breast.
RESULTS: A total of 103 patients were consented consecutively. Average age was 54 years (SD 9.6), and of the 174 breasts evaluated, 86 (49.4%) were TRAMs, 83 (47.7%) were DIEPS, and 5 (2.9%) were other. When evaluating mean sensation of the whole breast, there were no differences at 6-weeks (P=0.356), 3-months (P=0.276), 6-months (P=0.669), though at 12-months the FN+ cohort had superior sensation (P=0.040) (FIGURE). For both cohorts, sensation appeared to return between 3- and 6-months postoperatively.
CONCLUSION: Flap neurotization demonstrated higher intensity sensation compared to non-neurotized flaps as early as 3-6 months after autologous breast reconstruction. Neurotization does not appear to induce earlier sensation return, but it does with a greater magnitude. 
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