6. Breast Flap Neurotization After Autologous Free Flap Breast Reconstruction: A Prospective Trial

Abstract

Purpose: Restoration of breast sensation is an important factor to consider following autologous breast reconstruction (ABR). Flap neurotization may result in improved sensation after ABR, but current literature regarding both patient-reported outcomes and quantitative sensation after neurotization is inadequate and heterogenous. We present a prospective trial investigating the long-term outcomes of flap neurotization regarding breast sensation. Methods: 98 patients (n = 166 flaps) were prospectively evaluated for breast sensation and quality-of-life 1-5 years after ABR. This included 55 neurotized patients (n=97 neurotized breast flaps) and 44 non-neurotized patients (n=71 non-neurotized breast flaps). Evaluation consisted of the validated patient-reported questionnaire (BREAST-Q), a sensation-specific patient-reported questionnaire, and pressure-specified sensation testing at 9 locations on the breast using the AcroVal pressure-specified sensory device. Continuous variables were compared using independent t-tests. Categorical variables were compared using chi-squared analyses. Results: Non-neurotized patients were significantly more likely to report breast sensation was affecting their daily lives due to pain or discomfort, while neurotized patients were more likely to report they did not notice a difference in breast sensation after ABR or that the change in sensation was not affecting their daily lives (p= 0.035). While there was no significant difference in quantitative sensation between neurotized and non-neurotized patients at 1 year after ABR, neurotized patients were significantly more sensate at 4 of 9 testing locations on the breast (0.011<p<0.039) when evaluated 2-5 years after ABR. Conclusion: Breast sensation affects the daily lives of breast reconstruction patients and is an important long-term outcome to consider following ABR. Neurotization is associated with improved protective sensation as well as reduced pain and discomfort in the long-term after ABR.