Return of Sensitivity and Outcome Evaluation of Breast Reconstruction with the DIEP Free Flap

Abstract

Sir: We analyzed the results achieved in 20 patients selected randomly among 130 unilateral mammary reconstructions with noninnervated deep inferior epigastric perforator flaps performed 1 to 2 years previously. Our analysis consisted of four steps: Patients were interviewed with a self-evaluating questionnaire regarding the reasons why they had chosen autologous reconstruction, the degree of satisfaction, and the self-estimated sensitivity recovery (Table 1). Only one patient reported a complete absence of sensitivity, whereas all the others reported a sensitivity recovery comparable to the objective evaluated results. The average recovery time was 9 to 12 months. Breast outcome, scar quality, and donor site were evaluated by the same examiner. All of the reconstructions were satisfactory in terms of naturalness, symmetry, and softness. The only patient with poor symmetry reported an important weight loss. The surgeon was not completely satisfied with the breast shape in eight patients, even if the patients were completely satisfied. The scar quality was considered unsatisfactory in four cases: one was in a patient of African race and produced multiple keloids; three cases presented scar disorders in the median part of the abdomen. Thermal sensitivity was evaluated with tubes containing water at 4°C and 25°C; pain sensitivity was tested with 30-gauge needle punctures. Thermal and pain sensitivity presented similar recovery in all cases, with a better restoration of pain. On the reconstructed breasts (Fig. 1), recovery was better in the extremities and inferior part of the flap. The areola and the upper pole of the flap had poor recovery. On the donor site (Fig. 2), there was complete recovery in the extremities and poor recovery in the central part above the wound and in the umbilical area. In one patient, we observed complete recovery of thermal and pain sensitivity on the breast; and in one patient, we observed complete recovery on both the breast and the donor site. Pressure sensitivity was evaluated with the Semmes-Weinstein test. In the breast (Fig. 1), we observed a good recovery of pressure sensitivity in the medial and lower quadrants in nine cases. One patient presented good recovery of overall sensitivity in the reconstructed breast, and another patient presented complete absence of pressure sensitivity. On the donor site (Fig. 2), the best recovery of pressure sensitivity was in the extremities. In three cases, we found good recovery of pressure sensitivity on the entire abdomen. We observed a minor recovery in the umbilical area and in the area on the median part of the wound. Table 1: Reconstruction with the Deep Inferior Epigastric Perforator Flap: Self-Evaluating Questionnaire on Overall Patient SatisfactionTableFig. 1.: Points examined on the reconstructed breast: the best recovery is on the points in red (2, 3, and 4).Fig. 2.: Points examined on the abdomen: the best recovery is on the points in red (1, 3, 4, 5, and 6).We can conclude that most of the 20 examined patients had some sensitivity recovery attributable to reinnervation. Similar results were reported on patients who underwent reconstruction with transverse rectus abdominis musculocutaneous flaps.1–5 Patient satisfaction regarding the reconstruction was very high in most of the cases. The strong motivation to restore body image without any foreign body makes them appreciate the results more than what the surgeon would sometimes expect. Luca Negosanti, M.D. Matteo Santoli, M.D. Rossella Sgarzani, M.D. Stefano Palo, M.D. Riccardo Cipriani, M.D. Department of Plastic Surgery S. Orsola Hospital Bologna, Italy