Characterization of Long-Term Sensory Recovery at the Abdominal Donor Site Following Autologous Breast Reconstruction

Autologous breast reconstruction using abdominal tissue has become the gold standard approach to reconstruction following mastectomy. However, long term sensory loss at the donor site is a common yet understudied complication. This study aims to characterize abdominal sensory changes over time (> 3 years) to better inform patient-surgeon discussions.

Seventy-one patients who underwent unilateral or bilateral abdominal free flap breast reconstruction were stratified into four cohorts based on follow-up time (<1 year, >1 year, >2 years, and >3 years postoperatively; range: 0.24 to 6.79 years). Sensation was assessed using Semmes-Weinstein monofilaments at 93 abdominal sites. Data were analyzed using generalized linear models in R, and heat maps were generated to visualize sensory changes. Patient-reported outcomes were evaluated via the BREAST-Q 2.0 questionnaire.

Sensory heat maps demonstrated progressive improvement over time, with the infraumbilical midline and areas below the transverse scar most affected by sensory loss. Generalized linear models showed significant sensory recovery and improved scar appearance over time, while higher BMI and bilateral reconstruction were associated with reduced sensory recovery.

Sensory loss and scar appearance are common concerns following autologous breast reconstruction, but both show significant improvement over time. Sensory recovery is most limited in infraumbilical midline zones, while lateral zones demonstrate near-complete recovery. Poorer outcomes are associated with bilateral reconstruction and higher BMI. These findings provide valuable insights to enhance preoperative counseling by offering a detailed understanding of anticipated sensory changes.