A Prospective Study Comparing Breast Sensation in Neurotized and Non-Neurotized Autologous Free Flap Reconstructions using Electronic Pressure Sensory Gradients
Jessica R. Cunning, MD, MBA, Shelby L. Nathan, MD, Michael Tecce, DO, Robyn B. Broach, PhD, Cutler B. Whitely, BS, Arturo J. Rios-Diaz, MD, Joseph M. Serletti, MD.
University of Pennsylvania, Philadelphia, PA, USA.
Background: Restoration of breast sensation following autologous breast reconstruction is integral to the reconstructive paradigm for breast cancer patients. We sought to quantify the impact of neurotization in autologous breast reconstruction on sensation and quality of life (QoL).
Methods: A patient-blinded prospective study was undertaken for patients undergoing free-flap autologous breast reconstruction. Patients were assigned to a neurotized group or non-neurotized group. Using the Pressure-Specified Sensory Device™ to quantify sensation (range: 0-100, 100=lowest sensation), mastectomy and flap skin were tested in four poles at a minimum of 12-months postoperatively. Kruskal-Wallis tests were used to compare sensation, the primary outcome, and Breast-Q QoL scores, the secondary outcome, between cohorts at the flap-level.
Results: One-hundred and fifty-five flaps were tested, of which 49.7% were neurotized. Patients tended to be 53 years-old (Interquartile Range 46-61), White (82.2%), non-obese (BMI<30: 57.3%), and have muscle-sparing TRAM flaps (79.7%). Sensation was higher for the neurotized group at the superior mastectomy pole compared to the non-neurotized group (66.2 [33.5-96.4] vs. 83.2 [51.3-100]; p=0.03). However, sensation was lower at the inferior mastectomy pole for the neurotized group compared to the non-neurotized group. (91.6 [59.6-100] vs 76 [36-94.3]; p<0.01). Otherwise, sensation did not significantly differ between groups. Sensation was significantly decreased for patients who underwent radiation therapy (p>0.05) irrespective of neurotization. Of the flaps with minimal sensation (scores>90), sensation at the lateral mastectomy and lateral flap poles were significantly less for non-innervated TRAM flaps than non-innervated DIEP flaps (p=0.03 and p=0.03, respectively). However, no flap-type difference existed amongst innervated flaps (p>0.05). The neurotized group exhibited greater QoL compared to the non-neurotized group in 3 of the 11 QoL domains (p<0.05).
Conclusions: Neurotization during autologous breast reconstruction appears to increase sensibility in only one of four quadrants, whereas radiation impairs sensation regardless of innervation status. QoL was higher in the innervation cohort. Further analysis inclusive of change over time is needed as the study progresses.
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