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Neurotization of the Nipple-Areolar Complex during Implant-Based Reconstruction: Evaluation of Early Sensation
Recovery Isis Scomacao, MD; Rebecca Knackstedt, MD, PhD; Cagri Cakmakoglu, MD;
Stephen Grobmyer, MD; Risal Djohan, MDDepartment of Plastic Surgery, Cleveland Clinic, Cleveland, OH
• Patient’s undergoing mastectomy havedecreased protective and erogenous sensationand low quality of life outcome measures.
• Reviews have focused mainly on sensateautologous abdominally-based breastreconstruction.
AIM
• Determine the sensation recovery of the breastafter nipple sparing mastectomy (NSM) andimplant-based reconstruction associated withour novel neurotization technique of the nippleareolar complex (NAC).
CONTACT INFORMATION
INTRODUCTION
METHODS
• A database was prospectively maintained forpatients who underwent implant-based sensatebreast reconstruction.
• Technique approach: anterior branch of thelateral fourth intercostal was identified andpreserved during the mastectomy by the breastsurgeon. A processed nerve graft is utilized asan interpositional graft connecting the donor 4thintercostal nerve to the targeted (NAC). A nerveconnector was utilized (Figure 1).
• This is the first study to report on early resultsobtained after performing sensate implant-basedbreast reconstruction.
• It can be noticed a tendency of sensationrestoration of the NAC after implant-basedreconstruction with neurotization.
RESULTS• Twelve patients underwent sensate implant-
based breast reconstruction. Eight patients withfifteen breasts were monitored for sensoryrecovery (table 1).
• Eleven breasts had direct to implantreconstruction and four had tissue expandersplaced.
0
20
40
60
80
100
Superio
r
Medial
Inferior
Lateral
UOQUIQ LIQ LO
Q
Mastectomy skin NAC skin
0
20
40
6080
100
Superio
r
M
edial
Inferior
Lateral
UOQ UIQ LIQ LOQ
NAC area
4.2mo 10.6mo
• The sensory recovery process was objectivelymonitored using a pressure sensory device(PSD). A static and dynamic tests wereperformed at standardized post-operative timepoints.
• Fifteen breasts underwent one post-operativesensation test (graph1), five of which underwenttwo post-operative sensation tests (graph 2).Two patients underwent bilateral reconstructionand unilateral neurotization, providing aninherent control breast (Graph 3).
Graph 1: First sensory test (4.2mo of follow up)
* Superior, medial, inferior, lateral are static tests; UOQ, UIQ, LIQ, LOQ are moving tests
Graph 2: Progression of sensory recovery –nipple areolar complex
* Superior, medial, inferior, lateral are static tests; UOQ, UIQ, LIQ, LOQ are moving tests
* Superior, medial, inferior, lateral are static tests; UOQ, UIQ, LIQ, LOQ are moving tests
0
20
40
60
80
100
Superio
r
Medial
Inferior
Lateral
UOQUIQ LIQ LO
Q
NAC area – 7.9mo
Neurotized breast Non-neurotized breast
Graph 3: Comparison neurotized breast vs non-neurotized breast
Figure 1: Technique approach
Characteristics
Age 38.12± 7.5
BMI 23.66± 4.19
Specimen weight 381.04± 149.5
Bilateral reconstruction 7 (47%)
Prophylactic mastectomy 11 (7.3%)
IMF incision 14 (93.3%)
Complication rate (minor) 5 (3.3%)
Table 1: Patient’s characteristics
CONCLUSIONS
• Isis Scomacao: [email protected], [email protected].
