Bridging the Gap: A Pilot Study on the Efficacy of Nerve Allografts in Autologous Breast Reconstruction

Abstract

Background: Breast anesthesia is commonly reported after mastectomy and reconstruction. During deep inferior epigastric perforator (DIEP) flap reconstruction, we coapt at least one of the T10–12 thoracoabdominal nerves within the flap to the anterior cutaneous branch of the 3rd intercostal nerve using a nerve allograft. We aim to evaluate the efficacy of nerve grafting in improving sensory recovery following neurotized DIEP flap reconstruction. Methods: Thirty patients (54 breasts) underwent immediate neurotized DIEP flap reconstruction using nerve grafts. Sensitivity evaluation was performed in nine breast regions. For each patient, sensation was compared between two time points: 3 to 6 months postoperatively versus 12 to 24 months postoperatively. The reconstructive BREAST-Q was used to survey patients’ satisfaction of their breasts, physical wellbeing, psychosocial wellbeing, and sexual wellbeing. Results: At 3 to 6 months postoperatively, patients had a mean sensitivity measurement of 52.1 g/mm2. At 12 to 24 months postoperatively, patients had a mean sensitivity measurement of 40.3 g/mm2. There was a significant decrease in the mean cutaneous threshold required for patients to perceive sensation between the two time points (–29.1 percent, p = 0.041). On the reconstructive BREAST-Q, patients scored significantly higher in breast satisfaction (56.7/100 versus 75.1/100, +32.5 percent, p = 0.032) and physical wellbeing (66.0/100 versus 85.5/100, +20.2 percent, p = 0.022) between the two time points. Conclusions: Patients who undergo nerve graft-based DIEP flap reconstruction can expect significant improvements in sensation to pressure over time. This improvement found on sensory testing correlates with significant improvement in patients’ BREAST-Q scores.