by Beugels, Jop; Cornelissen,
Anouk J. M.; van Kuijk, Sander M. J.; Lataster, Arno; Heuts, Esther M.;
Piatkowski, Andrzej; Spiegel, Aldona J.; van der Hulst, René R. W. J.; Tuinder,
Stefania M. H
Background: The sensory recovery of the breast remains an undervalued aspect of
autologous breast reconstruction. The aim of this study was to evaluate the
effect of nerve coaptation on the sensory recovery of the breast following DIEP
flap breast reconstruction and to assess the associations of length of
follow-up and timing of the reconstruction.
Methods: A prospective comparative study was conducted of all patients who
underwent either innervated or noninnervated DIEP flap breast reconstruction
and returned for follow-up between September of 2015 and July of 2017. Nerve
coaptation was performed to the anterior cutaneous branch of the third
intercostal nerve. Semmes-Weinstein monofilaments were used for sensory testing
of the native skin and flap skin.
Results: A total of 48 innervated DIEP flaps in 36 patients and 61 noninnervated
DIEP flaps in 45 patients were tested at different follow-up time points. Nerve
coaptation was significantly associated with lower monofilament values in all
areas of the reconstructed breast (adjusted difference, −1.2; p < 0.001),
which indicated that sensory recovery of the breast was significantly better in
innervated compared with noninnervated DIEP flaps. For every month of
follow-up, the mean monofilament value decreased by 0.083 in innervated flaps
(p < 0.001) and 0.012 in noninnervated flaps (p < 0.001). Nerve
coaptation significantly improved sensation in both immediate and delayed
reconstructions.
Conclusions: This study demonstrated that nerve coaptation in
DIEP flap breast reconstruction is associated with a significantly better
sensory recovery in all areas of the reconstructed breast compared with
noninnervated flaps. The length of follow-up was significantly associated with
the sensory recovery.
