Single- vs. Dual-Nerve Coaptation in DIEP Flap Breast Reconstruction: A Pilot Study on Early Sensory Recovery and...

This study compared sensory and patient-reported outcomes following single- versus dual-nerve coaptation in autologous breast reconstruction.

In a prospective cohort study (2022-2025), women undergoing nipple- or skin-sparing mastectomy with immediate deep inferior epigastric perforator flap reconstruction received single- or dual-nerve coaptation (one vs two donor-to-recipient sensory nerve coaptations). Tactile thresholds (g/mm²) were measured across nine breast regions using a Pressure-Specified Sensory Device preoperatively and at 3, 6, and 9 months. BREAST-Q surveys were administered at 9 months.

Fifty patients (91 breasts) were included (dual: 23 patients/43 breasts; single: 27 patients/48 breasts), with comparable baseline characteristics (p > 0.05).Recovery was similar at 3 months (37.3% vs 39.5%, p = 0.71), diverged at 6 months (43.5% vs 56.8%, p = 0.08), and was significantly greater with dual coaptation at 9 months (48.0% vs 65.6%, p = 0.04). At 6 months, dual coaptation demonstrated greater recovery in the outer superior (87.8% vs 41.1%, p < 0.001) and inner lateral (47.5% vs 23.4%, p = 0.029) regions. At 9 months, significant differences were observed in the outer superior (84.3% vs 51.4%, p = 0.008), outer lateral (80.6% vs 55.3%, p = 0.047), and inner lateral (56.6% vs 32.8%, p = 0.027) regions.At 9 months, BREAST-Q Sensation and Psychosocial Well-Being scores were higher in the dual-neurotized cohort (2.09 vs 1.41, p = 0.03; 3.11 vs 2.42, p = 0.01).

Dual-nerve coaptation is associated with greater tactile recovery and higher patient-reported sensation and psychosocial well-being than single-nerve coaptation.