Feeling the Difference? A Comparison of Sensory Return in Implant vs. Deep Inferior Epigastric Flap Breast Reconstruction
Nancy Qin*, Grant G. Black, Marcos Lu Wang, Yunchan Chen, David Otterburn
Weill Cornell Medical College, New York, NY
Breast anesthesia is frequently reported by patients after mastectomy and reconstruction due to the disruption of sensory nerves during surgery. This study aims to examine and compare the return of sensation over time between implant-based and autologous-based reconstruction.
In this prospective study, we identified and followed all patients who underwent mastectomy and immediate alloplastic or neurotized deep inferior epigastric perforator (DIEP) flap reconstruction. Neurosensory testing was performed in 9 breast regions using a pressure-specified sensory device at pre- and post-operative time points. Measurements were stratified temporally and by reconstructive method, then compared using unpaired t-tests with an alpha of 0.05.
A total of 234 patients (709 breasts) were included, with 130 patients (418 breasts) in the DIEP cohort and 104 patients (291 breasts) in the alloplastic cohort. Some patients underwent testing at multiple timepoints. Sensitivity measurements were comparable between the two groups at baseline (p>0.05). However, at less than 1 year postoperatively, the DIEP cohort showed significantly better sensory recovery (44.3% of baseline for DIEP vs. 37.8% for alloplastic, p<0.02). This trend continued 1-2 years postoperatively (56.2% for DIEP vs. 40.5% for alloplastic, p<0.01). 2-4 years postoperatively, breast sensation returned to comparable levels (58.1% for DIEP vs. 60.7% for alloplastic, p>0.05). Finally, at more than 4 years postoperatively, the DIEP cohort again demonstrated better sensory recovery (72.4% for DIEP vs. 60.8% for alloplastic, p<0.01).
Overall, neurotized autologous reconstruction yields superior sensory recovery compared to implant-based breast reconstruction. The difference in sensory recovery is noticeable both in the short and long run after mastectomy. Future clinical trials are warranted to better understand the trajectory of sensory recovery after mastectomy, and the role that reconstruction plays in this recovery.
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