Nerve Coaptation Improves
the Sensory Recovery of the Breast in DIEP Flap Breast Reconstruction
by Beugels, Jop; Bijkerk, Ennie; Lataster, Arno; Heuts,
Esther M.; van der Hulst, René R. W. J.; Tuinder, Stefania M. H.
Plastic and Reconstructive Surgery: August 2021 -
Volume 148 - Issue 2 - p 273-284
Background: Restoring the sensation of the reconstructed
breast has increasingly become a goal of autologous breast reconstruction. The
aim of this study was to analyze the sensory recovery of the breast and donor
site of innervated compared to noninnervated deep inferior epigastric
perforator (DIEP) flap breast reconstructions, to assess associated factors,
and to compare the differences between preoperative and postoperative
sensation.
Methods: A prospective cohort study was conducted, including
patients who underwent innervated or noninnervated DIEP flap breast
reconstruction between August of 2016 and August of 2018. Nerve coaptation was
performed to the anterior cutaneous branch of the third intercostal nerve.
Preoperative and postoperative sensory testing of the breast and donor site was
performed with Semmes-Weinstein monofilaments.
Results: A total of 67 patients with 94 innervated DIEP
flaps and 58 patients with 80 noninnervated DIEP flaps were included. Nerve
coaptation was significantly associated with lower mean monofilament values for
the breast (−0.48; p < 0.001), whereas no significant differences were found
for the donor site (−0.16; p = 0.161) of innervated compared to noninnervated
DIEP flaps. Factors positively or negatively associated with sensory recovery of
the breast and donor site were identified. Preoperative versus postoperative
comparison demonstrated significantly superior sensory recovery of the breast
in innervated flaps (adjusted difference, −0.48; p = 0.017).
Conclusions: This study demonstrated that nerve coaptation
in DIEP flap breast reconstruction significantly improved the sensory recovery
of the breast compared to noninnervated flaps. The sensory recovery of the
donor site was not compromised in innervated reconstructions. The results
support the role of nerve coaptation in autologous breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
