When patients undergo a nipple-and-skin-sparing mastectomy, the breast skin tends to be numb after surgery. Sensation may return over time, however, the extent of that sensation recovery is hard to predict. Nerve grafting at the time of mastectomy can greatly increase the chances that the patient will regain sensation in the breast. Our surgeons can use a nerve graft from a sensory nerve that comes out of the chest wall. That graft is connected to another sensory nerve in the region of the nipple areola.
Types of procedures
To restore sensation, nerves can be reconnected in several ways:
- Nerves can be stitched directly to each other
- When there is a space between two nerves, a nerve allograft and nerve connectors can be used to line up and attach the nerves.
- The nipple-and-skin-sparing mastectomy is performed by a breast surgeon
- While the mastectomy is underway, a plastic surgeon begins the process of preparing nerve grafts
- Nerve grafts are stitched to a sensory nerve on the chest wall
- A breast implant is placed to complete the breast reconstruction
- Using microsurgery techniques, the nerve graft from the chest wall is connected to a target, sensory nerve in the region of the nipple areola
- In the months after surgery, the nerves will re-sprout, potentially improving sensation
Risks & Benefits
Connecting nerves in order to improve sensation can add to the length and technical difficulty of surgery. Also, not all patients will have restored sensation.
Since many patients will get at least some sensation back over time, even without the additional step of reconnecting nerves, most plastic surgeons do not feel the need to add this procedure. With high quality mastectomies, even more sensation may remain on the reconstructed breast. What we know is that satisfaction rates are higher if sensation is restored, and the risk of post-mastectomy pain may be less.
Frequently Asked Questions
Is reconnecting nerves an option if my breasts were reconstructed with natural tissue?
Yes, natural tissue reconstruction patients can undergo a procedure that connects nerves in the flap to nerves in the chest.
Since nerves are cut as part of this procedure, will I have more pain?
When nerves at the mastectomy site are connected to nerves on the flap, there is little risk of added pain.