Download - Department of Plastic Surgery,Cleveland Clinic, Cleveland, OH · Neurotizationof the Nipple-Areolar Complex during Implant-Based Reconstruction: Evaluation of Early Sensation Recovery

Neurotization of the Nipple-Areolar Complex during Implant-Based Reconstruction: Evaluation of Early Sensation

Recovery Isis Scomacao, MD; Rebecca Knackstedt, MD, PhD; Cagri Cakmakoglu, MD;

Stephen Grobmyer, MD; Risal Djohan, MDDepartment of Plastic Surgery, Cleveland Clinic, Cleveland, OH

• Patient’s undergoing mastectomy havedecreased protective and erogenous sensationand low quality of life outcome measures.

• Reviews have focused mainly on sensateautologous abdominally-based breastreconstruction.

AIM

• Determine the sensation recovery of the breastafter nipple sparing mastectomy (NSM) andimplant-based reconstruction associated withour novel neurotization technique of the nippleareolar complex (NAC).

CONTACT INFORMATION

INTRODUCTION

METHODS

• A database was prospectively maintained forpatients who underwent implant-based sensatebreast reconstruction.

• Technique approach: anterior branch of thelateral fourth intercostal was identified andpreserved during the mastectomy by the breastsurgeon. A processed nerve graft is utilized asan interpositional graft connecting the donor 4thintercostal nerve to the targeted (NAC). A nerveconnector was utilized (Figure 1).

• This is the first study to report on early resultsobtained after performing sensate implant-basedbreast reconstruction.

• It can be noticed a tendency of sensationrestoration of the NAC after implant-basedreconstruction with neurotization.

RESULTS• Twelve patients underwent sensate implant-

based breast reconstruction. Eight patients withfifteen breasts were monitored for sensoryrecovery (table 1).

• Eleven breasts had direct to implantreconstruction and four had tissue expandersplaced.

0

20

40

60

80

100

Superio

r

Medial

Inferior

Lateral

UOQUIQ LIQ LO

Q

Mastectomy skin NAC skin

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40

6080

100

Superio

r

M

edial

Inferior

Lateral

UOQ UIQ LIQ LOQ

NAC area

4.2mo 10.6mo

• The sensory recovery process was objectivelymonitored using a pressure sensory device(PSD). A static and dynamic tests wereperformed at standardized post-operative timepoints.

• Fifteen breasts underwent one post-operativesensation test (graph1), five of which underwenttwo post-operative sensation tests (graph 2).Two patients underwent bilateral reconstructionand unilateral neurotization, providing aninherent control breast (Graph 3).

Graph 1: First sensory test (4.2mo of follow up)

* Superior, medial, inferior, lateral are static tests; UOQ, UIQ, LIQ, LOQ are moving tests

Graph 2: Progression of sensory recovery –nipple areolar complex



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Superio

r

Medial

Inferior

Lateral

UOQUIQ LIQ LO

Q

NAC area – 7.9mo

Neurotized breast Non-neurotized breast

Graph 3: Comparison neurotized breast vs non-neurotized breast

Figure 1: Technique approach

Characteristics

Age 38.12± 7.5

BMI 23.66± 4.19

Specimen weight 381.04± 149.5

Bilateral reconstruction 7 (47%)

Prophylactic mastectomy 11 (7.3%)

IMF incision 14 (93.3%)

Complication rate (minor) 5 (3.3%)

Table 1: Patient’s characteristics

CONCLUSIONS

• Isis Scomacao: [email protected], [email protected].