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Longitudinal Comparison Of Quantitative Sensory Outcomes In Patients With Direct-to-implant Breast Reconstruction With Nerve Allograft And Gender-affirming Mastectomy With Direct Nerve Coaptation
Lior Levy MD1, Makayla Kochheiser BA
1, Kristyn Vicente BA
1, Katya Remy MD
2, Chase Alston BS
1, Lisa Newman MD
1, Alexander Swistel MD
1, Rachel Simmons MD
1, Vivian Bea MD
1, Katherine H. Carruthers MD
2, Eleanor Tomczyk MD
2, William G Austen Jr MD
2, Ian L Valerior MD
2, Lisa Gfrerer MD
1
1Weill Cornell Medicine, New York City, NY, USA; 2Harvard Medical School, Boston, MA, USA
PURPOSE: This study aims to compare sensory outcomes in patients with targeted nipple areola complex (NAC) reinnervation (TNR) with direct-to-implant (DTI) breast reconstruction and gender-affirming mastectomy (GAM).
METHODS: Patients undergoing DTI reconstruction (n=32) and GAM (n=74) were prospectively followed and completed Quantitative Sensory Testing (QST) with monofilament, pinprick, 2-point discrimination, vibration, temperature, and pressure preoperatively and at 1, 3, 6, and 12 months postoperatively.
RESULTS: Preoperative sensation was comparable between groups. Postoperatively, monofilament testing was significantly better at the chest and NAC in GAM patients at each timepoint (Figure 1). At 12 months, all sensory tests were significantly better at the chest in patients with GAM except for pressure, which was similar between groups. Pinprick, vibration, and cold temperature detection was significantly better at the NAC in patients with GAM; 2-point discrimination, heat detection, and pressure were similar (Figure 2). At 12 months, all sensory tests had returned to baseline in the GAM group except chest pressure, chest and NAC heat detection, and NAC pinprick. In DTI patients, vibration had reached baseline at 12 months.
CONCLUSION: TNR resulted in improved sensation in DTI reconstruction and GAM patients, with GAM returning and DTI approaching the preoperative baseline sensation.
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