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Alloplastic Vs. Autologous Reconstruction: Contrasting Thermal And Pressure Sensory Outcomes
Nancy Qin, BS, Makayla Koshheiser, BA, Lucy Wei, BS, Anna M. Vaeth, BS, Ashley Zhang, BS, Marcos Lu Wang, MD, Hao Huang, MD, David M. Otterburn, MD.
Weill Cornell Medical College, New York, NY, USA.
PURPOSE:While several studies have compared alloplastic and autologous breast reconstruction in terms of infection rates, cosmetic outcomes, and quality of life, few have addressed sensory restoration. This study examines tactile and thermal sensory recovery across these methods.
METHODS:Patients undergoing mastectomy with immediate tissue expander (TE) or neurotized DIEP-flap reconstruction, without radiation, were assessed preoperatively and postoperatively. Sensory testing was conducted across five distinct breast regions using a pressure-specified sensory device for tactile sensation and hot (52°C)/cold (12°C) packs for thermal sensation.
RESULTS:
215 patients (105 TE, 110 DIEP) underwent tactile testing, and a subset of 84 patients (44 TE, 40 DIEP) underwent thermal testing. DIEP and TE patients were comparable in age and comorbidities. Preoperative scores for pressure, heat, and cold perception were also comparable. The neurotized DIEP cohort exhibited significantly superior pressure perception at all postoperative time points compared to the TE cohort (
Figure 1). Conversely, the TE cohort demonstrated superior thermal perception at nearly all postoperative time points, with statistically significant differences for cold perception at 12-24 and 24-48 months, and for heat perception at 12-24 months.
CONCLUSION:Neurotized DIEP-flap reconstruction demonstrates superior pressure perception compared to TE reconstruction. However, TE reconstruction shows better thermal sensation, especially in later recovery. Further research is needed to explore the differing sensory recovery mechanisms, neurotization's role, and potential conductive effects of alloplastic material.
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