19. A Look at the Sequential Return of Breast Sensation after Autologous Breast Reconstruction: Is it Worth the Nerve Graft?

PURPOSE: Flap neurotization (FN) is increasingly being utilized to improve recovery of breast sensation in autologous breast reconstruction (ABR). Some literature shows the long-term effects of flap neurotization, but the short-term sequential timing of when sensation returns remains unknown. This study aimed to compare patients who underwent flap neurotization (FN+) versus patients who did not undergo flap neurotization (FN-) to determine if neurotization accelerates time to sensation. METHODS: A prospective study was designed in which patients underwent either FN+ or FN- during ABR. Flap neurotization was achieved by bridging a human nerve allograft to a T10/T11 intercostal sensory nerve in the flap. Each breast mound was divided into 9 regions and evaluated for sensation at 6 weeks, 3 weeks, 6 months, and 12 months postoperatively using the AcroVal pressure-specified sensation device. The means of sensation at each time point were compared with independent t-tests by region and by whole breast. RESULTS: A total of 103 patients were consented consecutively. Average age was 54 years (SD 9.6), and of the 174 breasts evaluated, 86 (49.4%) were TRAMs, 83 (47.7%) were DIEPS, and 5 (2.9%) were other. When evaluating mean sensation of the whole breast, there were no differences at 6-weeks (P=0.356), 3-months (P=0.276), or 6-months (P=0.669). However, at 12-months the FN+ cohort had superior sensation (P=0.040). For both cohorts, sensation appeared to return between 3- and 6-months postoperatively. CONCLUSION: This study presents the first large, prospective trial assessing the short-term effects of breast free flap neurotization on sensory recovery after ABR. Flap neurotization demonstrated higher intensity sensation compared to non-neurotized flaps as early as 3-6 months after autologous breast reconstruction. Neurotization does not appear to induce earlier sensation return, but it does with a greater magnitude.