Abstract
PurposeThe number of breast cancer survivors continues to grow. Due to refinements in operating techniques, autologous breast reconstruction has become part of standard care. Impaired sensation remains a debilitating side effect with a significant impact on the quality of life. Microsurgical nerve coaptation of a sensory nerve has the potential to improve sensation of the reconstructed breast. This study investigates the effect of improved sensation of the reconstructed breast on the quality of life in breast cancer survivors.MethodsA retrospective cohort study was performed in the Maastricht University Medical Center. Patients undergoing a DIEP flap breast reconstruction between January 2015 and January 2016 were included. The primary outcome was quality of life (BREAST-Q domain ‘physical well-being of the chest’). The Semmes–Weinstein monofilaments were used for objective sensation measurement of the reconstructed breast(s).ResultsEighteen patients with and 14 patients without nerve coaptation responded. Nipple reconstruction was the only characteristic that differed statistically significant between both groups (p = 0.04). The BREAST-Q score for the domain physical well-being of the chest was 77.89 ± 18.89 on average in patients with nerve coaptation and 66.21 ± 18.26 in patients without nerve coaptation (p = 0.09). Linear regression showed a statistically significant relation between objectively measured sensation and BREAST-Q score for the domain physical well-being of the chest with a regression coefficient of − 13.17 ± 3.61 (p < 0.01).ConclusionsImproved sensation in the autologous reconstructed breast, with the addition of microsurgical nerve coaptation, has a statistical significant positive impact on the quality of life in breast cancer survivors according to the BREAST-Q.
Highlights
Used for objective sensation measurement of the reconstructed breast(s)
The effect of sensory nerve coaptation in patients with a DIEP flap breast reconstruction on the quality of life as measured by the BREAST-Q when compared to standard reconstruction without nerve coaptation was evaluated for the first time
The primary outcome was defined as the domain physical well-being of the chest, since we deemed it the most important quality of life measure related to sensation after breast reconstruction
Summary
This study was conducted according to the STROBE guidelines and was approved by the medical ethical committee of the Maastricht University Medical Center [32]. Patients were invited to complete the BREAST-Q questionnaire (Dutch for the Netherlands, reconstruction module) and five additional questions about breast sensation in particular (Table 1). Patients were asked to complete the domains that are likely to be influenced by sensation of the breast: physical well-being of the chest, psychosocial well-being, sexual well-being, satisfaction with breasts and satisfaction with outcome. These domains were used as separate outcome variables, as a total BREAST-Q score cannot be computed. The primary outcome was defined as the domain physical well-being of the chest, since we deemed it the most important quality of life measure related to sensation after breast reconstruction. Does the sensation in your reconstructed breast resemble the sensation of your healthy breast before operation?
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