How to Assess Sensory Recovery After Breast Reconstruction Surgery?

Puonti, Helena K.; Broth, Taina A.; Soinila, Seppo; Hallikainen, Helena K.; Jääskeläinen, Satu K.

doi:10.1016/j.clbc.2017.04.011

Cited by 13 publications

(12 citation statements)

References 28 publications

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“…Twenty-three studies were found that met parameters for inclusion into this review. Of the studies included, seven looked primarily at DIEP flaps, 3,5-10 nine looked primarily at TRAM flaps, [11][12][13][14][15][16][17][18][19] two studies were novel implantbased studies, 20,21 and the remaining five studies dealt with other reconstructive modalities, including some where a technique was not specified. [22][23][24][25][26]…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Functional and Psychosocial Outcomes following Innervated Breast Reconstruction: A Systematic Review

Abbas

Klomparens

Simman

2022

Plastic and Reconstructive Surgery - Global Open

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Background: With the incidence of breast cancer, breast cancer survival rates, and prophylactic mastectomies all increasing, efforts to optimize breast reconstruction and improve quality of life are becoming increasingly important. Nerve coaptation has been investigated for its potential to remedy the clinical and psychosocial deficits in newly reconstructed breasts. The purpose of this review is to gauge the efficacy of nerve coaptation during breast reconstruction in creating worthwhile benefits in both objective and subjective dimensions of sensation. Methods: A Prospero registered systematic review was conducted. Databases including PubMed, SCOPUS, and ScienceDirect were screened using search terms “innervation," “breast reconstruction," and “neurotization” and relevant inclusion criteria. Results: Twenty-three studies were found that met parameters for inclusion. We identified studies that assessed DIEP-based reconstruction (7), TRAM-based reconstruction (9), implant-based reconstruction (2), and five studies that looked at a variety of reconstructive modalities. Monofilament testing was the most common modality used to assess sensation, while pain, temperature, and pressure thresholds were assessed more infrequently. Various tools were used to measure psychosocial impacts, including the BREAST-Q. While the methods for evaluation of both aspects of sensation were heterogenous, there was a trend towards improved outcomes with neurotization. Conclusions: The results of this review show promising improvements in clinical and psychosocial outcomes in innervated breasts compared to non-innervated breasts. However, the heterogeneity of studies in the literature indicates that more multi-center studies with standardized methodology including the BREAST-Q, sensory testing and complication analysis are needed to adequately demonstrate the value of neurotization in breast reconstruction.

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Section: Resultsmentioning

confidence: 99%

“…Nine studies were identified that looked specifically at innervation during TRAM reconstruction. [11][12][13][14][15][16][17][18][19] Among these studies, there were 172 innervated TRAM flaps and 91 non-innervated TRAM flaps across a combined total of 251 patients. The most common modality for sensory testing was again SWMF.…”

Section: Tram Studiesmentioning

confidence: 99%

Functional and Psychosocial Outcomes following Innervated Breast Reconstruction: A Systematic Review

Abbas

Klomparens

Simman

2022

Plastic and Reconstructive Surgery - Global Open

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“…The current study detected an increase in the warmth detection threshold only in patient 5 at the 12-month follow-up (V5). This points to an effect on C-fibers, whose recovery is usually slower than large-caliber fibers [ 46 ]. The time point at which this effect appeared suggests a potential relationship between chemotherapy and the generated hypoesthesia [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…Participant 3 underwent surgery only and did not show substantial differences compared to those receiving endocrine therapy. The literature is contradictory about the association between hormone therapy and pain, with some studies finding an association [ 6 , 16 , 46 ], while others do not [ 5 , 56 , 57 ]. However, none of the included women who were treated with hormone therapy solely developed pain during this treatment.…”

Section: Discussionmentioning

confidence: 99%

Changes in Pain Sensitivity in Treatment for Breast Cancer: A 12-Month Follow-Up Case Series

Lorenzo-Gallego

Arranz-Martín

Romay‐Barrero

et al. 2022

IJERPH

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This study aimed to investigate changes in the pain sensory profile of women with breast cancer. Five women with unilateral breast cancer were enrolled. Participants were assessed with direct (quantitative sensory testing, QST) and indirect measures of pain sensitization (self-reported central sensitization inventory, CSI) at baseline (before surgery), 1 week after surgery, and at 1, 6, 9, and 12 months post-surgery. In the event of pain occurrence, the Leeds Assessment of Neuropathic Symptoms and Signs was also used. Nociceptive pain was the predominant pain mechanism in the postoperative period, while an increase in sensitization predominated one year after breast cancer surgery, especially in those participants who had received more treatment procedures. The participants who received more therapies for breast cancer experienced persistent pain and a higher level of sensitization. An assessment protocol including direct measurements (QST) and indirect measurement (self-reported CSI) allows for detecting changes in pain sensitivity, which can be useful for characterizing and/or predicting pain before, during, and up to one year following surgical interventions for breast cancer.

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“…Furthermore, recent studies have focused on objective clinical assessment of nerve sensation to validate breast neurotization following microsurgery or guide clinical practice with regard to spontaneous reinnervation. 31 Having focused mainly on Semmes Weinstein and caloric metrics, the current literature does not necessarily assess subjective sensation in meaningful patient-reported outcomes. Larger studies with patient-reported outcomes are warranted to better assess sensation following neurotization, including the relative advantage of using medial or lateral intercostal nerves as a donor or harvesting of multiple nerve levels.…”

Section: Frontiers In Breast Reconstructionmentioning

confidence: 99%

Frontiers in Oncologic Reconstruction

Samra¹,

Sobti²,

Nelson

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Objectives: The authors seek to highlight some of the ongoing challenges related to complex oncologic reconstruction and the current solutions to these problems. Summary: The standard of care in reconstruction following oncologic resection is continually evolving. Current frontiers in breast reconstruction include addressing animation deformity through prepectoral reconstruction, offering autologous reconstruction to patients with limited donor sites, and improving postoperative sensation with innervation of free tissue transfer. Facial nerve reconstruction and contour defects pose an ongoing challenge in patients undergoing parotidectomy requiring complex nerve transfers and autologous reconstruction. Lymphedema is not a monolithic disease, and as our understanding of the pathophysiology improves, our surgical algorithms continue to evolve.

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How to Assess Sensory Recovery After Breast Reconstruction Surgery?

Cited by 13 publications

References 28 publications

Functional and Psychosocial Outcomes following Innervated Breast Reconstruction: A Systematic Review

Functional and Psychosocial Outcomes following Innervated Breast Reconstruction: A Systematic Review

Changes in Pain Sensitivity in Treatment for Breast Cancer: A 12-Month Follow-Up Case Series

Frontiers in Oncologic Reconstruction

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