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Sensory Recovery Following Targeted Nipple-Areola Complex Reinnervation in Direct-to-Implant Breast Reconstruction and Gender-Affirming Mastectomy
Makayla Kochheiser
*, Kristyn A. Vicente, Katya Remy, Chase Alston, William G. Austen, Ian Valerio, Lisa Gfrerer
Weill Cornell Medical College, New York, NY
Background: Loss of sensation is a common consequence of mastectomy in both breast reconstruction and gender-affirming surgery, contributing to reduced quality of life, impaired sexual health, and functional limitations. Nerve preservation and reinnervation techniques, such as nerve allografts or direct coaptation, aim to improve sensory outcomes. This study compares sensory recovery in patients undergoing targeted nipple-areola complex (NAC) reinnervation (TNR) with direct-to-implant (DTI) breast reconstruction using nerve allografts and gender-affirming mastectomy (GAM) utilizing direct coaptation.
Methods: Patients undergoing DTI reconstruction (
n = 32) and GAM (
n = 74) were prospectively followed at Weill Cornell Medicine and Massachusetts General Hospital from November 2021 to November 2024. Quantitative sensory testing (QST) with monofilament, pinprick, 2-point discrimination, vibration, temperature, and pressure was performed preoperatively and at 1, 3, 6, and 12 months postoperatively. Student t-tests were used to compare sensation to baseline and between groups at each timepoint.
Results: Preoperative sensation was similar between groups (
p > 0.05). Postoperatively, GAM patients had significantly better monofilament scores at the chest and NAC at all timepoints (
p < 0.05). At 12 months, all sensory tests were significantly better at the chest in GAM patients except for pressure, which was similar. NAC pinprick, vibration, and cold detection were also significantly better in GAM patients, while 2-point discrimination, heat detection, and pressure were similar. By 12 months, all sensory tests returned to baseline in GAM patients except chest pressure, NAC pinprick, and heat detection. In DTI patients, only vibration returned to baseline.
Conclusions: TNR improved sensation in both groups, with GAM patients achieving more complete and rapid recovery. These findings suggest that reinnervation facilitates sensory return, with direct coaptation potentially offering faster and more robust recovery than nerve allografts.
