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Feeling the Heat, Losing the Touch: Thermal and Tactile Sensation Changes After Chemotherapy and Radiation
Nancy Qin
1, Hao Huang
2, Grant Black
1, Ashley Zhang
3, Sophia Arbuiso
1, Makayla Kochheiser
1, Marcos Lu Wang
2, David Otterburn
2
1Weill Cornell Medical College, USA; 2Division of Plastic and Reconstructive Surgery, NewYork Presbyterian-Cornell Columbia, USA; 3Columbia University Vagelos College of Physicians and Surgeons, USA
Purpose: Sensory nerves exhibit slow recovery following mastectomy, with previous studies pinpointing mastectomy technique and reconstruction type as influential factors. However, the impact of chemotherapy and radiation therapy (XRT) on neural regeneration has received less attention in the literature.
Methods: Patients undergoing mastectomy with immediate reconstruction were prospectively followed. Thermal and tactile sensation testing was performed using hot/cold packs and a pressure-specified sensory device respectively. Patients were stratified based on preoperative or postoperative exposure to chemotherapy and/or XRT.
Results: A total of 255 patients (132 undergoing DIEP flap-based reconstruction and 123 undergoing implant-based reconstruction) were included in the study. Preoperative tactile and thermal sensation levels showed no correlation with neoadjuvant chemotherapy or neoadjuvant XRT. However, in the first year postoperatively, adjuvant XRT was found to have a negative impact on tactile sensation, with significant differences noted at 6 months (13.3-point decrease) and 12 months (19.8-point decrease) compared to non-irradiated patients. Between 6 and 12 months postoperatively, patients who underwent neoadjuvant chemotherapy (10.8-point decrease) and adjuvant chemotherapy (8.9-point decrease) exhibited significantly lower tactile sensation scores. Platinum-based chemotherapy in particular yielded worse tactile sensation compared to other chemotherapy regimens. Of note, these trends were not observed with thermal sensation (p>0.05). Beyond 1-year post-mastectomy, neither XRT nor chemotherapy were associated with diminished tactile or thermal breast sensation.
Conclusions: Although chemotherapy and XRT may delay tactile sensation restoration in the short term after mastectomy, they do not impact the long-term regenerative potential of these sensory nerves. Thermal sensation remains unaffected by these treatment regimens at any postoperative point.
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