When skin is included as part of a natural-tissue flap for breast reconstruction, that skin tends to be numb immediately after surgery. While sensation can come back over time, including a sensory nerve with the rest of the flap that is used at the time of breast reconstruction can increase the amount of sensation that returns. Flaps that include skin from the lower abdomen, thighs, and back have nerves that can be identified and connected with nerve allografts to nerves in the area of the reconstructed breast. This advanced procedure is called Resensation.
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 natural-tissue flap is designed in the usual way
- Nerves going to the skin of the flap are identified and preserved
- To complete the breast reconstruction, the chosen flap is transferred to the chest wall and blood vessels from the flap are connected to blood vessels in the chest.
- Using microsurgery techniques, the nerves from the flap are then connected to nerves on the chest
- 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 implants?
While it is not possible to reconnect nerves in implant breast reconstruction, patients can undergo a slightly different procedure that utilizes nerve grafting to improve the possibility of regaining sensation after surgery.
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.