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Sensory Outcomes Of Direct To Implant-based Breast Reconstruction With Targeted Nipple Areola Complex Reinnervation (TNR) Versus Control Patients: A Multicenter Prospective Cohort Study
Katya Remy, MD1, Kristyn Vicente, BA
2, Makayla Kochheiser, BA
2, Chase Alston, BS
2, Lisa Newman, MD
2, Alexander Swistel, MD
2, Rachel Simmons, MD
2, Vivian Bea, MD
2, Katherine H. Carruthers, MD
1, Eleanor Tomczyk, MD
1, William G. Austen, Jr., MD
1, Ian Valerio, MD
1, Lisa Gfrerer, MD PhD
2.
1Massachusetts General Hospital, Boston, MA, USA,
2Weill Cornell Medicine, New York, NY, USA.
PURPOSE: To analyze the sensory outcomes of targeted nipple areola complex (NAC) reinnervation (TNR) in nipple-sparring mastectomy with direct to implant-based breast reconstruction versus control patients.
METHODS: 32 subjects (59 +TNR breasts) were compared to 24 controls (40 -TNR breasts) using Quantitative Sensory Testing (QST) and the Breast-Q Sensory Module preoperatively and at 1, 3, 6, 9, 12 months postoperatively. Mechanical (monofilaments), vibration (tuning fork), two-point discrimination, pinprick, temperature (automated thermal device) and pressure pain (algometer) detection were measured at the breast and NAC.
RESULTS: A median of 2 (1-3) nerves were reconstructed with nerve allograft (2-7cm). QST and Breast-Q Sensory scores were significantly improved in subjects versus controls starting at 3 months postoperatively and reached baseline starting at 12 months (Fig1,2,3). Subjects reported significantly less breast pain starting at 1 month (44% vs 84%, p=0.02) through 12 months postoperatively (13% vs 50%, p=0.06).
CONCLUSION: Compared to control, direct to implant-based breast reconstruction with TNR is associated with improved sensation and less breast pain. Long-term outcomes are required to understand the full potential of TNR.
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