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Quantifying Thermal and Tactile Recovery in Dual-Neurotized Breast Flaps: A Pilot Intra-Patient Control Study
Nancy Qin¹, Makayla Kochheiser¹, Carson Gundlach^*1, Lucy Wei¹, Anna M. Vaeth¹, Malini Chinta², Hao Huang², Jasmine Yu¹, David Otterburn^2
1Weill Cornell Medical College, New York, NY; ²Division of Plastic and Reconstructive Surgery, New York Presbyterian, New York, NY

BACKGROUND
This pilot study is the first to quantify tactile and thermal sensory recovery relative to baseline in patients undergoing mastectomy and immediate dual-neurotized autologous reconstruction.

METHODS
Patients undergoing mastectomy with deep inferior epigastric perforator (DIEP) flap reconstruction were prospectively enrolled. Dual-nerve coaptation was performed using two thoracoabdominal donor nerves and the anterior and lateral branches of the T3 intercostal recipient nerves.

Neurosensory testing was performed preoperatively and at 3, 6, and 9 months postoperatively. Tactile sensation was measured across nine breast regions using a pressure-specified sensory device. Thermal sensation was assessed across five breast regions using hot (52°C) and cold (12°C) packs. Scores were compared to baseline, with all patients serving as their own controls (α = 0.05).

RESULTS
Twenty-nine breasts from 16 patients were included. The average age was 51.8 years, and the mean body mass index was 27.5 kg/m². Tactile sensation improved from 48.7% of baseline at 3 months to 69.5% at 6 months and 70.9% at 9 months (p < 0.001, compared to baseline). Recovery varied by region, with the outer superior area showing the greatest recovery (94.1% at 9 months, p = 0.265), followed by the outer medial (87.7%), outer lateral (81.4%), and outer inferior (72.7%) regions. The nipple-areolar complex (NAC) exhibited the poorest tactile recovery (57.5%, p < 0.001).

For thermal sensation, 56%, 72%, and 73% of breast regions correctly perceived heat at 3, 6, and 9 months, respectively (p < 0.001, compared to baseline), while cold perception remained limited (38%, 46%, and 43%, p < 0.001). As with tactile recovery, the superior region showed the greatest thermal return (93.8% heat; 75% cold), whereas the NAC showed the poorest (43.8% heat; 6.3% cold).

CONCLUSION
This is the first study to evaluate sensory outcomes following mastectomy and dual-neurotized DIEP reconstruction, providing a baseline reference to guide surgical decision-making and counseling.