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Breast Cancer Research and Treatment

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Open Access 01-06-2020 | Breast Cancer | Clinical trial

Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation

Authors: Ennie Bijkerk, Sander M. J. van Kuijk, Arno Lataster, René R. W. J. van der Hulst, Stefania M. H. Tuinder

Published in: Breast Cancer Research and Treatment | Issue 3/2020

Abstract

Background

Patient satisfaction after breast reconstruction is dependent on both esthetics and functional outcomes. In an attempt to improve breast sensibility, a sensory nerve coaptation can be performed. The aim of this study was to objectify the sensory recovery in patients who, by chance, underwent bilateral autologous breast reconstruction with one innervated and one non-innervated flap. It must be emphasized that the intention was to coaptate the sensory nerves on both sides.

Methods

The cohort study was carried out in the Maastricht University Medical Center between August 2016 and August 2018. Patients were eligible if they underwent bilateral non-complex, autologous breast reconstruction with unilateral sensory nerve coaptation and underwent sensory measurements using Semmes–Weinstein monofilaments at 12 months of follow-up. Sensory outcomes were compared using t tests.

Results

A total of 15 patients were included, all contributing one innervated and one non-innervated flap. All patients had a follow-up of at least 12 months, but were measured at different follow-up points with a mean follow-up of 19 months. Sensory nerve coaptation was significantly associated with better sensation in the innervated breasts and showed better sensory recovery over time, compared to non-innervated breasts. Moreover, the protective sensation of the skin can be restored by sensory nerve coaptation.

Conclusions

The study demonstrated that sensory nerve coaptation leads to better sensation in the autologous reconstructed breast in patients who underwent bilateral breast reconstruction and, by chance, received unilateral sensory nerve coaptation.

Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Niksic M, Bonaventure A, Valkov M, Johnson CJ, Esteve J, Ogunbiyi OJ, Azevedo ESG, Chen WQ, Eser S, Engholm G, Stiller CA, Monnereau A, Woods RR, Visser O, Lim GH, Aitken J, Weir HK, Coleman MP, Groue CW (2018) Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet 391(10125):1023–1075. https://doi.org/10.1016/S0140-6736(17)33326-3 CrossRefPubMedPubMedCentral

Schreuder K, van Bommel ACM, de Ligt KM, Maduro JH, Vrancken Peeters M, Mureau MAM, Siesling S (2017) Hospital organizational factors affect the use of immediate breast reconstruction after mastectomy for breast cancer in the Netherlands. Breast 34:96–102. https://doi.org/10.1016/j.breast.2017.05.011 CrossRefPubMed

Hartmann LC, Lindor NM (2016) The role of risk-reducing surgery in hereditary breast and ovarian cancer. N Engl J Med 374(5):454–468. https://doi.org/10.1056/NEJMra1503523 CrossRefPubMed

Yueh JH, Slavin SA, Adesiyun T, Nyame TT, Gautam S, Morris DJ, Tobias AM, Lee BT (2010) Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg 125(6):1585–1595. https://doi.org/10.1097/PRS.0b013e3181cb6351 CrossRefPubMed

Cornelissen AJM, Beugels J, van Kuijk SMJ, Heuts EM, Rozen SM, Spiegel AJ, van der Hulst R, Tuinder SMH (2018) Sensation of the autologous reconstructed breast improves quality of life: a pilot study. Breast Cancer Res Treat 167(3):687–695. https://doi.org/10.1007/s10549-017-4547-3 CrossRefPubMed

Beugels J, Cornelissen AJM, van Kuijk SMJ, Lataster A, Heuts EM, Piatkowski A, Spiegel AJ, van der Hulst R, Tuinder SMH (2019) Sensory recovery of the breast following innervated and noninnervated DIEP flap breast reconstruction. Plast Reconstr Surg 144(2):178e–188e. https://doi.org/10.1097/PRS.0000000000005802 CrossRefPubMed

General Assembly of the World Medical A (2014) World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. J Am Coll Dent 81(3):14–18

von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008 CrossRef

Spiegel AJ, Menn ZK, Eldor L, Kaufman Y, Dellon AL (2013) Breast reinnervation: DIEP neurotization using the third anterior intercostal nerve. Plast Reconstr Surg Glob Open 1(8):e72. https://doi.org/10.1097/GOX.0000000000000008 CrossRefPubMedPubMedCentral

10.

Spiegel AJ, Salazar-Reyes H, Izaddoost S, Khan FN (2009) A novel method for neurotization of deep inferior epigastric perforator and superficial inferior epigastric artery flaps. Plast Reconstr Surg 123(1):29e–30e. https://doi.org/10.1097/PRS.0b013e3181905564 CrossRefPubMed

11.

Rodriguez-Lorenzo A, Liu T, Mani M (2020) 'Breast reconstruction with neurotized deep inferior epigastric perforator flap' in Springer breast reconstruction: modern and promising techniques. Springer, Cham, pp 179–180

12.

Ducic I, Yoon J, Momeni A, Ahcan U (2018) Anatomical considerations to optimize sensory recovery in breast neurotization with allograft. Plast Reconstr Surg Glob Open 6(11):e1985. https://doi.org/10.1097/GOX.0000000000001985 CrossRefPubMedPubMedCentral

13.

Knackstedt R, Djohan R, Gatherwright J (2019) Anatomic location of a sensory nerve to the lateral thigh flap: a novel option for sensate autologous tissue reconstruction. J Plast Reconstr Aesthet Surg 72(3):513–527. https://doi.org/10.1016/j.bjps.2018.12.015 CrossRefPubMed

14.

Beugels J, Van Kuijk SMJ, Lataster A, Van der Hulst RRWJ, Tuinder SMH (2020) Sensory recovery of the breast following innervated and noninnervated lateral thigh perforator (LTP) flap breast reconstruction (submitted). Plast Reconstr Surg 144:178--CrossRef

15.

Saad A, Rebowe RE, Hogan ME, Wise MW, Hilaire HS, Sadeghi A, Dupin CL (2014) Localization of the dominant deep inferior epigastric artery perforator by computed tomography angiogram: does the standard deep inferior epigastric artery perforator flap design include the dominant perforator? Ann Plast Surg 72(6):670–673. https://doi.org/10.1097/SAP.0b013e31826a1897 CrossRefPubMed

16.

Tuinder SMH, Beugels J, Lataster A, de Haan MW, Piatkowski A, Saint-Cyr M, van der Hulst R, Allen RJ (2018) The lateral thigh perforator flap for autologous breast reconstruction: a prospective analysis of 138 flaps. Plast Reconstr Surg 141(2):257–268. https://doi.org/10.1097/PRS.0000000000004072 CrossRefPubMed

17.

Manual: Baseline® Tactile™ Semmes-Weinstein type monofilaments. Fabrication Enterprises Inc. Authorized CE representative: RMS UK Ltd. 28 Trinity Road. Nailsea, Somerset BS48 4NU (UK). ©2017, all rights reserved. Baseline and Tactile are trademarks of Goldberg

18.

Beugels J, Cornelissen AJM, Spiegel AJ, Heuts EM, Piatkowski A, van der Hulst R, Tuinder SMH (2017) Sensory recovery of the breast after innervated and non-innervated autologous breast reconstructions: a systematic review. J Plast Reconstr Aesthet Surg 70(9):1229–1241. https://doi.org/10.1016/j.bjps.2017.05.001 CrossRefPubMed

19.

Bijkerk E, van Kuijk SMJ, Beugels J, Cornelissen AJM, Heuts EM, van der Hulst R, Tuinder SMH (2019) Breast sensibility after mastectomy and implant-based breast reconstruction. Breast Cancer Res Treat 175(2):369–378. https://doi.org/10.1007/s10549-019-05137-8 CrossRefPubMedPubMedCentral

20.

Liu Y, Sun GW (2015) Repair, protection and regeneration of peripheral nerve injury. Neural Regen Res 10(11):1789. https://doi.org/10.4103/1673-5374.170301 CrossRef

21.

Grinsell D, Keating CP (2014) Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies. Biomed Res Int 2014:698256. https://doi.org/10.1155/2014/698256 CrossRefPubMedPubMedCentral

22.

Davies F, Gladstone RJ, Stibbe EP (1932) The anatomy of the intercostal nerves. J Anat 66(Pt 3):323–333PubMedPubMedCentral

23.

Yap LH, Whiten SC, Forster A, Stevenson JH (2002) The anatomical and neurophysiological basis of the sensate free TRAM and DIEP flaps. Br J Plast Surg 55(1):35–45. https://doi.org/10.1054/bjps.2001.3746 CrossRefPubMed

24.

Nielsen TD, Moriggl B, Barckman J, Kolsen-Petersen JA, Soballe K, Borglum J, Bendtsen TF (2018) The lateral femoral cutaneous nerve: description of the sensory territory and a novel ultrasound-guided nerve block technique. Reg Anesth Pain Med 43(4):357–366. https://doi.org/10.1097/AAP.0000000000000737 CrossRefPubMed

25.

Lee MW, McPhee RW, Stringer MD (2008) An evidence-based approach to human dermatomes. Clin Anat 21(5):363–373. https://doi.org/10.1002/ca.20636 CrossRefPubMed

26.

Bijkerk E, Cornelissen AJM, Sommer M, Van Der Hulst R, Lataster A, Tuinder SMH (2019) Intercostal nerve block of the anterior cutaneous branches and the sensibility of the female breast. Clin Anat. https://doi.org/10.1002/ca.23532 CrossRefPubMed

Title: Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation
Authors: Ennie Bijkerk
Sander M. J. van Kuijk
Arno Lataster
René R. W. J. van der Hulst
Stefania M. H. Tuinder
Publication date: 01-06-2020
Publisher: Springer US
Keywords: Breast Cancer
Breast Cancer
Published in: Breast Cancer Research and Treatment / Issue 3/2020
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-020-05645-y

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