Is the sensitivity of skin‐sparing mastectomy or nipple‐sparing mastectomy superior to conventional mastectomy with innervated flap?

Abstract

The purpose of this study was to investigate sensory recovery in 33 patients who underwent conventional mastectomy, skin-sparing mastectomy, or nipple-sparing mastectomy with immediate breast reconstruction using abdominal flaps. Reconstructions included a pedicled transverse (28 cases) or vertical (five cases) rectus abdominis musculocutaneous flap. Sensory reconstruction was performed in 15 cases by neurorrhaphy using intercostal nerve. Patients were classified into six groups according to type of mastectomy and use of neurorrhaphy. Sensory recovery was estimated by touch, pain, and hot and cold sensation at the nipple, areola, and 4 points at a distance of 2 cm from the areolar circumference. For touch sensation, conventional mastectomy with innervated flap provided greater sensitivity than the other groups (P < 0.05). For pain sensation, conventional mastectomy with innervated flap provided greater sensitivity than the other groups (P< 0.05). In terms of short-term postoperative sensitivity, skin- and nipple-sparing mastectomies with abdominal flap appear inferior to conventional mastectomy with innervated abdominal flap.

Improved sensory recovery with a novel dual neurorrhaphy technique for breast reconstruction with free muscle sparing TRAM flap technique

“…Neither was there any difference in nipple sensation between delayed and immediate breast reconstruction, showing that the collateral reinnervation from surrounding skin could not improve the nipple sensitivity in immediate reconstruction group. Interestingly, in line with our results on late‐stage recovery, an earlier study shows that skin‐ and nipple‐sparing mastectomies with an abdominal flap compared to conventional mastectomy with an innervated abdominal flap have been less successful in terms of short‐term sensitivity, tactile sensation and pain sensation . Furthermore, some patients have acquired burns to their recently reconstructed non‐innervated DIEP‐breasts because of hot water, sun‐bathing or hot items, which indicates thermal hypoalgesia or analgesia in the reconstructed breast …”

Evaluation of Sensation on Mastectomy Skin Flaps following Immediate Breast Reconstruction

“…Mori and Okazaki showed that conventional mastectomy with innervated flap was superior in sensory recovery than SSM and NSM. 30 They also demonstrated that there was no supplementary benefit to neurorrhaphy of flaps in reconstruction following NSM and SSM. They have attributed this to dominance of superficial neural network over deep neural network.…”

Pilot study of breast sensation after breast reconstruction: Evaluating the effects of radiation therapy and perforator flap neurotization on sensory recovery

“…48 Temple et al 48 used three validated questionnaires for assessing the quality of life after innervated free TRAM flaps and found a statistically significant improvement in all three for the innervated free TRAM group compared with the noninnervated free TRAM group. 48 A more recent study by Mori et al 49 evaluated sensory recovery in 33 patients who underwent (conventional, skin sparing, or nipple sparing) mastectomy with immediate breast reconstruction using abdominal flaps. Sensory reconstruction was performed in 15 cases by neurorrhaphy using intercostal nerve.…”