Comparing Autologous to Device-Based Breast Reconstruction: A Pilot Study of Return in Breast Sensation
Hao Huang, BS, Marcos Lu Wang, BA, Angela Ellison, PA-C, David M. Otterburn, MD
NewYork-Presbyterian - Weill Cornell, New York, NY
Background: While breast reconstruction following mastectomy has many proven benefits, poor breast sensation is commonly reported due to the necessary disruption of sensory nerves during surgery. Further, the process of nerve regeneration is slow and unpredictable, causing some patients to experience suboptimal sensation years after initial reconstruction. In this study, we aim to delineate the temporal pattern of sensory changes following breast reconstruction and to compare the return in sensation between autologous and device-based reconstruction.
Methods: 87 women who are undergoing or underwent mastectomy with immediate reconstruction, including 41 patients (75 breasts) with deep inferior epigastric perforator (DIEP) flap and 46 patients (78 breasts) with tissue expander (TE), were prospectively identified at their preoperative or postoperative visit at defined time points. Sensitivity evaluation was performed in nine breast regions, utilizing the AcroVal pressure-specified sensory device (AxoGen, Alachua, FL) to determine 1 point-static cutaneous thresholds at which stimulus was perceived. Higher thresholds indicated worse sensitivity. Sensitivity data was averaged between patients at each time point, plotted over time, and compared between the two groups. Results: DIEP flap patients had an average age of 51.5 and an average BMI of 27.3 kg/m2, compared to 51.6 and 25.6 kg/m2 in TE patients, respectively (p>0.05). Breast size was comparable between the two groups (p>0.05). DIEP flap patients were significantly more likely to undergo nipple-sparing mastectomy (90.2 vs 65.2%, p=0.006). There were no significant differences in chemotherapy or radiotherapy. The DIEP flap group was associated with predictable changes in sensitivity over time (Figure 1A). Compared to preoperative baseline, mean cutaneous thresholds at 18 months postoperatively were comparable only in the outer superior, outer medial, and outer lateral regions (p>0.05). On the other hand, cutaneous thresholds at 24 months or more postoperatively were comparable to baseline in all regions of the breast except the inner inferior region. The TE group was associated with a slower and less predictable return in sensitivity (Figure 1B). Compared to baseline, mean cutaneous thresholds were significantly worse in all regions of the breast at both 18 months and 24 months or more postoperatively (p<0.05). Conclusions: Autologous reconstruction is superior in sensory recovery. Patients who undergo DIEP flap can expect sensory return to preoperative levels by 24 months or more postoperatively, with sensation returning even sooner in some areas of the breast. Patients who undergo device-based reconstruction should expect a slower return in breast sensation and be counseled accordingly prior to surgery.
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