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Direct Neurotization Feasibility With Intercostal Nerve in Autologous Breast Reconstruction: A Cadaveric Study
Mohamad Rachadian Ramadan1, Risal Djohan2, Kristaninta Bangun1
1From the Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Background:
Restoring breast sensation has the potential to improve a patient's quality of life after breast reconstruction. With recent advances in breast neurotization, sensory restoration has become possible. This study aimed to map the lateral cutaneous branch (LCB) of the fourth intercostal nerve (ICN) and assess the feasibility of direct neurotization in autologous breast reconstruction.
Methods:
Bilateral chest dissections were performed in 10 cadavers. The LCB of the fourth ICN was identified along the lateral sternal border, the midclavicular line, and the anterior axillary line. The total potential length of the donor ICNs was measured, and the cross-sectional areas (CSAs) of the combined nerve grafts were compared with the CSA of the LCB using the Wilcoxon signed-rank test.
Results:
All LCB of the fourth ICN were identified. Median distances were 14.90 (13.50-16.75) cm from the lateral sternal border, 7.75 (6.25-10.00) cm from the midclavicular line, 0.25 (0.00-1.38) cm from the anterior axillary line, and 12.50 (12.00-13.00) cm from the clavicle. The median potential graft length was 43.75 (40.50-48.38) cm. Median CSAs of ICN 3-4 and 4-5 were 1.42 (1.42-1.91) and 1.57 (1.31-1.69) mm2, compared with 1.22 (1.13-2.54) mm2 for the LCB. No significant differences were found (P = 0.58 and P = 0.55, respectively).
Conclusions:
Direct neurotization using the ICNs is anatomically feasible for autologous breast reconstruction and represents a practical alternative when nerve allografts are unavailable.
