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Comparing Single- and Dual-Nerve Coaptation in DIEP Flap Breast Reconstruction: Impact on Sensory Recovery and Patient-Reported Outcomes
Nancy Qin^*1, Makayla Kochheiser¹, Carson Gundlach¹, Annie B. McVeigh¹, Anna M. Vaeth¹, Hao Huang², Marcos Lu Wang², 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 compares sensory recovery and patient-reported outcomes in patients undergoing single- versus dual-neurotized deep inferior epigastric perforator (DIEP) flap breast reconstruction.

METHODS
Patients undergoing mastectomy with DIEP flap reconstruction (2023-2025) received either single-nerve (T3 anterior branch; pre-2024) or dual-nerve coaptation (T3 anterior and lateral branches; post-2024). Sensory testing was performed preoperatively and postoperatively at 3, 6, and 9 months using a pressure-specified sensory device across nine breast regions. Postoperative scores were averaged across regions and expressed as a percentage of each patient's baseline sensation. Additionally, at 6 months postoperatively, patient-reported outcomes were assessed using the BREAST-Q Reconstruction and Sensation Modules.

RESULTS
This study included 50 single-neurotized breasts (29 patients) and 30 dual-neurotized breasts (16 patients), with comparable demographics, comorbidities, and oncologic regimens.

At 3 months postoperatively, the dual-neurotized group demonstrated better sensory recovery compared to the single-neurotized group (54.8% vs. 41.2%), approaching statistical significance (p = 0.092). This difference became significant at 6 months (70.3% vs. 42.5%, p = 0.002) and persisted at 9 months (74.8% vs. 47.0%, p = 0.015).

Within the BREAST-Q Reconstruction Module, cohorts were comparable in breast satisfaction, physician satisfaction, chest physical well-being, and sexual well-being. However, psychosocial well-being was significantly higher in the dual-neurotized group (3.24 vs. 2.78, p = 0.041), specifically in areas of emotional health, self-confidence, femininity, and normalcy.

Within the BREAST-Q Sensation Module, the dual-neurotized cohort reported significantly higher scores in the breast sensation domain (1.65 vs. 1.13, p = 0.045), while breast symptoms and sensation-related quality of life scores were comparable.

CONCLUSION
This pilot study supports the use of dual-nerve coaptation in DIEP flap reconstruction to enhance sensory and psychosocial outcomes.