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

Magarakis, Michael; Venkat, Raghunandan; Dellon, A. Lee; Shridharani, Sachin M.; Bellamy, J; Vaca, Elbert E.; Jeter, Stacie C.; Zoras, Odysseas; Manahan, Michele A.; Rosson, Gedge D.

doi:10.1002/micr.22124

Cited by 53 publications

(85 citation statements)

References 49 publications

(152 reference statements)

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“…The evidence is particularly sparse for clinical evaluation of sexual function and outcomes in girls and adolescents with cancer, and surprisingly little is known about how to evaluate breast sexual function. 233 Research and practice expertise is also needed to better serve particularly marginalized groups, including women with cancer and sexual concerns who are older or widowed, those who identify with a sexual or gender minority group, women with physical and/or cognitive disability, and women receiving palliative or hospice care. Some women do wish to remain sexually active until the end of life; as a matter of compassion and human rights, institutional hospice care settings should ensure patient privacy and support symptom alleviation for comfortable and safe sexual activity.…”

Section: Resultsmentioning

confidence: 99%

Physical examination of the female cancer patient with sexual concerns: What oncologists and patients should expect from consultation with a specialist

Lindau

Abramsohn

Baron

et al. 2016

CA A Cancer J Clinicians

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Sexual concerns are prevalent in women with cancer or cancer history and are a factor in patient decision-making about cancer treatment and risk-reduction options. Physical examination of the female cancer patient with sexual concerns, regardless of the type or site of her cancer, is an essential and early component of a comprehensive evaluation and effective treatment plan. Specialized practices are emerging that focus specifically on evaluation and treatment of women with cancer and sexual function problems. As part of a specialized evaluation, oncologists and their patients should expect a thorough physical examination to identify or rule out physical causes of sexual problems or dysfunction. This review provides oncology professionals with a description of the physical examination of the female cancer patient with sexual function concerns. This description aims to inform anticipatory guidance for the patient and to assist in interpreting specialists’ findings and recommendations. In centers or regions where specialized care is not yet available, this review can also be used by oncology practices to educate and support health care providers interested in expanding their practices to treat women with cancer and sexual function concerns.

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Section: Resultsmentioning

confidence: 99%

Physical examination of the female cancer patient with sexual concerns: What oncologists and patients should expect from consultation with a specialist

Lindau

Abramsohn

Baron

et al. 2016

CA A Cancer J Clinicians

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“…The finding of improved breast sensation postoperatively with innervation has also been demonstrated in TRAM flaps, including one randomized controlled trial . While studies compared results with and without nerve grafts, only one utilized a nerve conduit . However, there is significant variability among the studies in regards to surgical protocols, nerves and grafts utilized and postoperative sensory testing, making comparison between studies difficult …”

Section: Discussionmentioning

confidence: 95%

Collaboration between the breast and plastic surgeon in restoring sensation after mastectomy

2019

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Breast cancer is the most commonly diagnosed invasive cancer in women worldwide. While hypoesthesia is a known sequela after mastectomy, patients are now inquiring with renewed interest about the degree and timing of sensation after mastectomy. This is a topic that has generated much research interest. However, while there have been advances in the field, there are few, well‐done studies that allow for an accurate answer to this question. In this article, relevant breast and donor site anatomy is reviewed for sensate autologous breast reconstruction. Additional donor sites apart from the typically utilized abdomen are analyzed with relevant anatomical discussions. Outcomes are presented; however, due to the heterogeneity of the patient population, surgical approach and postoperative sensory testing, it is difficult to compare results between studies. Future directions and unanswered questions regarding sensate autologous breast reconstruction are highlighted. While great strides have been made in providing sensate autologous breast reconstruction, there are still many unanswered questions. Thus, the collaboration between surgical teams and sharing of outcomes is crucial to allow for optimization of this powerful surgical approach.

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“…Future studies directly comparing large cohorts of immediate, staged, and delayed reconstructions, ideally prospectively, may help confirm potential benefits of the widespread use of tissue expanders, even in eventual autologous tissue reconstruction. Our study lacks patient reported outcomes and Quality of Life data, such as the BREAST‐Q, which may vary depending on the timing of reconstruction and whether the selected reconstructive option leads to an aesthetically pleasing and sensate breast . Additionally, our study is based on the protocols used at our institution, which may or may not be generalizable to other reconstructive programs.…”

Section: Discussionmentioning

confidence: 99%

Long-term follow-up of changing practice patterns in breast reconstruction due to increased use of tissue expanders and perforator flaps

et al. 2014

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Background: As the science of breast reconstruction evolves, significant changes in reconstruction strategies and outcomes are expected. The purpose of this study is to determine the changes in breast reconstruction trends and outcomes that occurred at a multidisciplinary academic institution during the last decade. Methods: We compared 265 patients over two distinct 6-month intervals separated by 5 years (2002 vs. 2007) and performed long-term follow-up (4.75 6 3.38 years 2002, 2.99 6 2.25 years 2007). We studied patients seeking prophylactic mastectomy, patients with early breast cancer, and patients with locally advanced disease. We analyzed demographic data, breast cancer history and treatment, type and timing of reconstruction, and complications. Results: Implant to flap reconstruction ratio was 48:49 in 2002 and 76:102 in 2007. Use of transverse rectus abdominis myocutaneous flap declined from 57 to 4%; conversely, deep inferior epigastric perforator flap increased from 27 to 91% (P < 0.001). Correspondingly, donor site chronic pain (4 vs. 0, P 5 0.012) and postoperative abdominal wall bulge (9 vs. 3, P 5 0.004) rates decreased. Timing of reconstruction showed increased staged cases in 2007 compared to 2002 (P 5 0.045). Post-final reconstruction radiation therapy was reduced in 2007 (P 5 0.016), with subsequent lower rates of implant rupture (P < 0.001). Conclusions: At our institution and over the last decade, increasing staged reconstructions have successfully reduced the rates of post-final reconstruction radiotherapy with optimized outcomes. Contrary to national trends, the rates of autologous flap reconstructions have increased with reduced donor site morbidity. This suggests that academic breast reconstruction trends are independent from national trends. V C 2014 Wiley Periodicals, Inc. Microsurgery 34:595-601, 2014.

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

Abstract: Without irradiation, skin overlying implants is associated with better sensation recovery than DIEP flap skin. However, with irradiation, DIEP flap skin had better sensation recovery than did skin over implants. Neurotization trended toward improvement in sensation in DIEP flaps.

Cited by 53 publications

References 49 publications

Physical examination of the female cancer patient with sexual concerns: What oncologists and patients should expect from consultation with a specialist

Physical examination of the female cancer patient with sexual concerns: What oncologists and patients should expect from consultation with a specialist

Collaboration between the breast and plastic surgeon in restoring sensation after mastectomy

Long-term follow-up of changing practice patterns in breast reconstruction due to increased use of tissue expanders and perforator flaps

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