by Knackstedt,
Rebecca; Gatherwright, James; Cakmakoglu, Cagri; Djohan, Michelle; Djohan,
Risal
Summary: The
sensory innervation to the breast originates from the medial and lateral
cutaneous branches of the third to fifth intercostal nerves, which are at risk
for injury or loss during mastectomy. Providing reinnervation after mastectomy
was introduced almost 20 years ago, but it is not widely performed, perhaps
because of the difficulty of locating a recipient nerve. The authors have
performed cadaveric dissections to allow for precise anatomical localization of
the lateral intercostal branch providing breast sensation. Bilateral chest dissections
were performed on 10 female cadavers. The lateral intercostal nerve providing
sensation to breast tissue was identified. The distances from the sternum, the
midclavicular line, and the lateral pectoralis minor—in addition to nerve
diameter—were measured. The nerve was successfully identified bilaterally in
all cadavers. The majority of nerves (16 of 20) exited from under the fourth
rib. The average distance from the sternum was 13.1 ± 1.3 cm (range, 10 to 15
cm) and the average distance from the midclavicular line was 11.8 ± 2.2 cm
(range, 8 to 16 cm). The nerve exited at the lateral border of the pectoralis
minor or within 2 cm from the lateral border for all cadavers. The diameter of
the nerve was consistently 2 mm. The nerve traveled under the thoracodorsal
vessels, aiding in identification. The authors identified the predictable
location of the lateral intercostal nerve providing sensation to the breast.
The authors hope that by enabling surgeons to locate this nerve, more
well-conducted studies will be performed investigating techniques and outcomes
for breast reinnervation.
