Comparing Autologous to Device-Based Breast Reconstruction

Huang, Hao; Wang, Marcos Lu; Ellison, Angela M.; Otterburn, David M.

doi:10.1097/sap.0000000000003073

Cited by 7 publications

(16 citation statements)

References 28 publications

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“…Among the studies that exist, most are cross-sectional and do not capture preoperative sensation levels, therefore limiting their ability to evaluate time-related changes and provide longitudinal assessments 10,16,20 . In our previous study, we concluded that DIEP flap reconstruction yielded not only faster recovery but also superior sensory return in comparison with implant-based reconstruction at all postoperative time points 15 . In this study, we further evaluate differences between the buried and nonburied DIEP flap groups after nipple- and skin-sparing mastectomies, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…10,16,20 In our previous study, we concluded that DIEP flap reconstruction yielded not only faster recovery but also superior sensory return in comparison with implant-based reconstruction at all postoperative time points. 15 In this study, we further evaluate differences between the buried and nonburied DIEP flap groups after nipple-and skin-sparing mastectomies, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, poor sensation after reconstruction remains a difficult challenge for surgeons 10–14 . In our previous study on breast sensation, we demonstrated that neurotized DIEP flap reconstruction was associated with superior sensory return in comparison with implant-based reconstruction, with sensations returning to preoperative levels within 3 years 15,16 …”

mentioning

confidence: 98%

“…[10][11][12][13][14] In our previous study on breast sensation, we demonstrated that neurotized DIEP flap reconstruction was associated with superior sensory return in comparison with implant-based reconstruction, with sensations returning to preoperative levels within 3 years. 15,16 In this study, we aim to further characterize sensory recovery in DIEP flap reconstructions by specifically comparing inner breast region sensation after nipple-sparing mastectomy with buried DIEP flap reconstruction to after skin-sparing mastectomy with nonburied DIEP flap reconstruction. Given that in nonburied DIEP flaps, the innervated DIEP skin flap is brought to the breast surface, we postulate that this cohort will yield better sensory return in the inner breast regions compared with buried DIEP flaps.…”

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confidence: 99%

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A Pilot Study Comparing Sensation in Buried Versus Nonburied Deep Inferior Epigastric Perforator Flaps

Wang¹,

Qin²,

Chadab

et al. 2023

Ann Plast Surg

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Background Neurotized deep inferior epigastic perforator (DIEP) flaps have been shown to improve sensory recovery after mastectomy and reconstruction. With the recent trend toward nipple-sparing mastectomies, sensation likely originates within the buried DIEP flap and then innervates the breast skin. In contrast, for patients undergoing skin-sparing mastectomies, the DIEP flap skin is preserved, brought up to the surface, and directly innervated. In this study, we aim to evaluate inner breast region sensation between patients whose DIEP flap is buried and whose DIEP flap skin is brought to the surface. Methods Seventy patients who underwent mastectomy with immediate reconstruction using the DIEP flap were prospectively identified. Of these, 60 patients underwent nipple-sparing mastectomy with buried DIEP flap reconstruction while 10 patients underwent skin-sparing mastectomy with nonburied DIEP flap reconstruction. Patients in both cohorts received nerve grafting using the 70 × 1–2-mm Avance Nerve Graft in identical fashion. Sensitivity evaluation was performed in five inner breast regions (corresponding to the nonburied DIEP flap area). Results In the buried DIEP cohort, at 6 months postoperatively, there was a statistically significant difference in inner breast region sensitivity measurements compared with baseline levels (P < 0.001). In contrast, in the nonburied DIEP cohort, at 6 months postoperatively, sensation in the inner breast region was comparable with preoperative baseline levels (P = 0.236). At 24 months postoperatively, inner breast region sensitivity measurements in both cohorts were comparable with preoperative baseline measurements (P > 0.05). Conclusions Neurotized DIEP flap skin raised directly to the surface confers earlier sensory recovery than buried DIEP flaps. In patients who undergo skin-sparing mastectomies with nonburied DIEP flap reconstruction, they can expect significantly better sensation in the inner regions of the breast at 6 months postoperatively. In patients who undergo nipple-sparing mastectomies with buried DIEP flap reconstruction, they can expect sensation in the inner breast to return to preoperative baseline levels at a later time point—beginning as early as 24 months postoperatively.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

mentioning

confidence: 99%

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A Pilot Study Comparing Sensation in Buried Versus Nonburied Deep Inferior Epigastric Perforator Flaps

Wang¹,

Qin²,

Chadab

et al. 2023

Ann Plast Surg

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“…5 Regardless of reconstructive method, breast numbness and poor sensory return remain an ongoing issue in breast reconstruction. [6][7][8] The breasts play a critical role in a woman's sexual health and self-image; previous studies on patient-reported outcomes using the BREAST-Q survey have found that restoring breast sensation can significantly improve quality of life. 9,10 Furthermore, the lack of protective sensation can predispose patients to injury; for example, thermal burns from common household items due to breast numbness have been reported in the literature.…”

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An Evolving Landscape

Black,

Chen,

Qin

et al. 2024

Ann Plast Surg

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Purpose Loss of breast sensation after mastectomy has been well documented. Postoperative reinnervation of the breast is influenced by factors including reconstructive technique, patient comorbidities, and adjuvant treatment. However, little attention has been paid to the differences in sensation across regions of the breast and the impact of reconstructive method on these regional differences over time. Methods Patients undergoing nipple-sparing mastectomy with immediate autologous or alloplastic reconstruction were prospectively followed. Neurosensory testing was performed in 9 breast regions using a pressure-specified sensory device. Patients were stratified by reconstructive technique, and regional sensation was compared at different preoperative and postoperative time points using Student t tests. Results One hundred ninety-two patients were included; 106 underwent autologous reconstruction via neurotized deep inferior epigastric artery perforator flap, and 86 underwent 2-stage alloplastic reconstruction. Preoperative sensation thresholds did not differ between reconstructive cohorts in any region and averaged 18.1 g/mm2. In the first year after mastectomy, decreased sensation was most pronounced in the inner breast regions and at the nipple areolar complex (NAC) in both reconstructive cohorts. At 4 years postoperatively, sensation increased the most at the NAC in the alloplastic cohort (34.0 g/mm2 decrease) and at the outer lateral region in the autologous cohort (30.4 g/mm2 threshold decrease). The autologous cohort experienced improved sensation compared with the alloplastic cohort in 5 of 9 regions at 1 year postoperatively, and in 7 of 9 regions at 4 years postoperatively; notably, only sensation at the outer superior and outer medial regions did not differ significantly between cohorts at 4 years postoperatively. Conclusions Although patients undergoing breast reconstruction experience increased breast sensation over time, the return of sensation is influenced by type of reconstruction and anatomic region. Regions closer to and at the NAC experience the greatest loss of sensation after mastectomy, although the NAC itself undergoes the most sensation recovery of any breast region in those with alloplastic reconstruction. Autologous reconstruction via a neurotized deep inferior epigastric artery perforator flap results in increased return of sensation compared with alloplastic reconstruction, particularly in the inferior and lateral quadrants of the breast.

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