Quantifying Thermal and Tactile Recovery in Dual-Neurotized Breast Flaps: A Pilot Intrapatient Control Study

Dual-nerve neurotization of deep inferior epigastric perforator (DIEP) flaps may enhance postmastectomy reinnervation, but the early timeline and regional patterns of tactile and thermal recovery remain incompletely defined.

We conducted a prospective, single-institution study (January 2024-September 2025) of women undergoing immediate dual-neurotized DIEP flap breast reconstruction. Anterior and lateral intercostal branches (T3/T4) were coapted to medial and lateral flap donor nerves (T10-T12). Objective sensory testing was performed preoperatively and at 3, 6, and 9 months. Tactile thresholds were normalized to each breast's baseline and reported as percent recovery. Thermal perception (hot 52°C; cold 12°C) was analyzed as regional accuracy. All analyses were performed within-breast.

Twenty-three patients (43 breasts) were included. Composite tactile recovery increased from 44.9% ± 29.2% at 3 months to 55.5% ± 27.0% at 6 months and 64.2% ± 24.8% at 9 months (all P  < 0.001). Regional recovery followed a superomedial pattern. By 9 months, outer-superior (85.6%) and outer-medial (85.9%) regions were not different from baseline ( P  > 0.05), whereas the NAC (46.0%) and inferior regions (41%-65%) remained reduced ( P  < 0.001). Thermal recovery improved over time. Cold accuracy increased to 48% ± 20% by 9 months ( P  < 0.001), with only the superior region approaching baseline ( P > 0.05). Hot accuracy recovered more robustly (9 months: 67% ± 28%; P  < 0.001), with superior, medial, and inferior regions reaching baseline equivalence ( P  > 0.05).

Dual-neurotization yields progressive tactile and thermal recovery within 9 months, most pronounced in the superior and medial breast, establishing early benchmarks for sensory outcomes after dual-neurotized DIEP reconstruction.