Sensory Outcomes after Neurotization in Nipple-sparing Mastectomy and Implant-based Breast Reconstruction

Mastectomy and breast reconstruction techniques continue to evolve to optimize aesthetic and reconstructive outcomes. However, the loss of sensation after mastectomy remains a major limitation. This article describes our evolution of a novel approach that we first described in 2019, combining recent advances in breast oncologic, reconstructive, and peripheral nerve surgery to optimize sensory outcomes.

Nipple-sparing mastectomy was performed in all patients and involved preservation of lateral intercostal nerves when anatomy was favorable. When nerves could not be preserved without compromising oncologic safety, nipple-areolar complex neurotization was performed using allograft or intercostal autograft from a transected T₃, T_4, or T_5, lateral intercostal nerve to identified subareolar nerve targets. Immediate, prepectoral, direct-to-implant reconstruction was then performed. Acroval one-point moving and one-point static pressure thresholds established baseline sensibility values, which were then repeated at multiple time points postoperatively.

Outcomes from 47 women (79 breasts) were assessed prospectively. Mean follow-up was 9.2 months (range 6-14 months). At 6 months postoperatively, over 80% of patients had good-to-excellent one-point moving as well as one-point static sensibility scores averaged across all areas tested. None of the patients developed persistent dysesthesia or clinical evidence of neuroma.

This study represents the largest series reported to date of sensibility outcomes after nipple-sparing mastectomy and implant reconstruction with concurrent neurotization. Sensibility results show that this approach allows for preservation of high degrees of breast and nipple-areolar complex sensation in most patients.