Sensory Outcomes and Neurotization Techniques Following Mastectomies: A Comprehensive Systematic Review

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Neuroscience

Background:

• Loss of breast sensation post-mastectomy significantly impacts patient quality of life.
• Increasing survival rates necessitate improved functional outcomes in breast reconstruction.
• Restoring sensation is a key goal in oncologic breast reconstruction.

Purpose of the Study:

• To systematically review sensory outcomes following neurotized breast reconstruction.
• To evaluate the efficacy of various neurotization techniques in restoring sensation.
• To assess the impact of sensory recovery on patient-reported quality of life.

Main Methods:

• Comprehensive literature search of PubMed, Embase, and Web of Science databases.
• Inclusion of 40 studies on autologous or implant-based breast reconstruction with neurotization.
• Analysis of objective sensory testing (monofilaments, pressure devices) and patient-reported outcomes (BREAST-Q).

Main Results:

• Neurotization accelerated and improved tactile, thermal, and protective sensation compared to controls.
• Direct coaptation, nerve allografts, conduits, and autografts were effective neurotization methods.
• Improved sensation correlated with higher patient satisfaction and quality of life.

Conclusions:

• Nerve coaptation is a promising adjunct for sensory restoration in both autologous and implant-based breast reconstruction.
• Various techniques including direct suture, conduits, and grafts demonstrate efficacy.
• Further high-quality, randomized studies are needed due to limitations in current evidence.