Long-Term Sensation in Neurotized Autologous Free Flap Breast Reconstruction: A Prospective Trial
Ankoor A. Talwar1, Abhishek A. Desai1, Phoebe B. McAuliffe1, Adrienne N. Christopher1, Viren Patel1, Martin Morris1, Robyn B. Broach1, Joseph M. Serletti1, Michael G. Tecce1
1University of Pennsylvania, Philadelphia, PA
Background: Restoration of breast sensation is an important factor to consider following autologous breast reconstruction (ABR). Flap neurotization may result in improved sensation after ABR, but current literature regarding both patient-reported outcomes and quantitative sensation after neurotization is inadequate and heterogenous. We present a prospective trial investigating the long-term outcomes of flap neurotization regarding breast sensation.
Methods: Patients were prospectively evaluated for breast sensation and quality-of-life after ABR, with and without neurotization. Evaluation consisted of the validated patient-reported questionnaire (BREAST-Q), a sensation-specific patient-reported questionnaire, and pressure-specified sensation testing at 9 locations on the breast using the AcroVal pressure-specified sensory device. This occurred at the following time periods after surgery: 6 weeks, 3 months, 6 months, and 12 months (short-term); and between 1-5 years (long-term). Continuous variables were compared using independent t-tests. Categorical variables were compared using chi-squared analyses.
Results: One hundred eighty-four patients were evaluated in the study. 86 patients (n = 145 flaps) were evaluated for short-term measurements of breast sensation and quality of life. 98 patients (n = 166 flaps) were evaluated for long-term measurements 1-5 years after ABR. The short-term cohort included 72 neurotized patients (n = 121 flaps) vs. 14 non-neurotized patients (n = 22 flaps). There were no differences in sensation testing at any breast location across short-term time periods. There were also no differences in short-term patient reporting of sensation. The long-term cohort included 55 neurotized patients (n = 97 flaps) and 44 non-neurotized patients (n = 71 flaps). Non-neurotized patients were significantly more likely to report breast sensation was affecting their daily lives due to pain or discomfort (p= 0.035). While there was no significant difference in quantitative sensation between neurotized and non-neurotized patients at 1 year after ABR, neurotized patients were significantly more sensate at 4 of 9 testing locations on the breast (all p < 0.05) when evaluated 2-5 years after ABR.
Conclusion: Breast sensation is an important consideration in ABR. Short-term breast sensation is not affected by breast flap neurotization. However, long-term sensation greater than 2 years after index reconstruction is improved in patients with neurotization, as well as improved patient-reported outcomes such as reduced pain and discomfort in the long-term after ABR.
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