By Bijkerk, Ennie;
Beugels, Jop; van Kuijk, Sander M. J.; Lataster, Arno; van der Hulst, René R.
W. J.; Tuinder, Stefania M. H.
Plastic and Reconstructive Surgery: November 2022
- Volume 150 - Issue 5 - p 959e-969e
Background:
Sensory nerve coaptation in autologous breast reconstruction
positively affects sensory recovery in the reconstructed breast. However,
patient-reported outcomes are lacking and no conclusions on the clinical
relevance of nerve coaptation could be drawn. The aim of this study was to
evaluate the clinical relevance of nerve coaptation in deep inferior epigastric
perforator (DIEP) flap breast reconstruction.
Methods:
A prospective cohort study was conducted of patients
undergoing innervated or noninnervated DIEP flap breast reconstruction between
August of 2016 and August of 2018. Patients completed a BREAST-Q questionnaire
at a minimum of 12 months’ follow-up in combination with either a preoperative
questionnaire or a questionnaire at 6 months’ follow-up. The physical
well-being of the chest domain was the primary outcome and patients answered
additional sensation-specific questions. Sensation was measured using
Semmes-Weinstein monofilaments.
Results:
In total, 120 patients were included (65 innervated and 55
noninnervated reconstructions). A clinically relevant difference was found in
BREAST-Q scores in favor of patients with innervated reconstructions in general
and for delayed reconstructions specifically. Patients with sensate breast
reconstruction more often reported better and pleasant sensation.
Conclusions:
This study demonstrated that nerve coaptation in DIEP flap
breast reconstruction, specifically in delayed reconstruction, resulted in
clinically relevant improved patient-reported outcomes on the physical
well-being of the chest domain of the BREAST-Q and that better sensation was
perceived. However, the BREAST-Q does not address sensation adequately, and the
introduction and validation of new scales is required to confirm the clinical
relevance of nerve coaptation reliably.
