Published on March 30, 2020
At a meeting of the American Society for Reconstructive Microsurgery (ASRM), I had the opportunity to interview Dr. James Craigie from the Center for Natural Breast Reconstruction in Charleston, S.C. for this important discussion on restoring sensation to the breast after mastectomy. This is done during breast reconstruction surgery. Women undergoing DIEP flap breast reconstruction frequently ask me, “Can sensation be restored to the breast after mastectomy?”
The short answer is yes, it can. However, not all plastic surgeons perform this procedure. In fact, it is done by surgeons trained in a sub-specialty of plastic surgery called microsurgery. Microsurgery requires advanced skills involving the art and science of connecting nerves and blood vessels under high powered microscopes. It takes the trained eye of a microsurgeon to perform nerve reconstruction.
What Type of Breast Reconstruction Can Restore Sensation?
Dr. Craigie explains that “natural breast reconstruction” involves using the patient's own tissue. After a mastectomy, the breast tissue is removed. Microsurgeons perform DIEP flap and other autologous (using your own tissue) breast reconstruction to replace the breast tissue with something that is similar to the native breast removed due to the effects of breast cancer. The tissue has both blood vessels and nerves for the microsurgeon to use.
Microsurgeons can restore the tissue, reconnecting the blood supply so that the new breast is living tissue as Dr. Craigie explains. The missing part of this process in years past has been restoring the nerves, also part of the natural tissue.
Dr. Craigie goes on to explain two important steps the microsurgeon does during the process:
- Finding the nerve that normally innervates (supplies nerves to) the breast in the breast area that was cut during mastectomy.
- Connecting those nerves to the sensory nerves of the tissue used to rebuild the breasts.
The Finer Details of Restoring Sensation to the Breast during Breast Reconstruction Surgery
The tissue is removed and separated from the body leaving the sensory nerve intact with the tissue. They take only as much as needed so they don’t leave any unnecessary numb areas in the part of the body they take the tissue from.
In the past, the primary emphasis was placed on connecting the blood vessels, understandably. If the blood vessels are not connected successfully there is not much use in connecting the nerves. Through advancements in microsurgical techniques we continue to see more sensation restored to the breast after mastectomy through nerve reconstruction.
Dr. Craigie explains it is very important to find the sensory nerve, not the motor nerve. Great care is taken not to use the motor nerve which supplies the muscles. Damaging the motor nerve can potentially cause a higher incidence of hernia or bulging in the abdominal area when performing DIEP flap breast reconstruction.
After Surgery How Long Does It Take for Sensation to Return?
As the body heals, the nerves that are connected can then regenerate over time restoring sensation to the breast. Nerves grow and regenerate at approximately 1 mm per day. This is a variable measurement but in general it takes up to a year for sensation to happen over time. It is not the same sensation a patient experienced before mastectomy but as Dr. Craigie points out, the more sensation that can be returned, the better.
Keep in mind the areas sensation returns to the breast can vary from one patient to the next. The area of the skin and nerves taken to rebuild the breast will determine where the new sensation is in the breast. The nerves can actually travel through the fatty tissue and eventually get to the skin. Dr. Craigie and I both agree there is a lot of consideration and variability to this procedure for each individual case.
Future Advancements in Restoring Sensation to the Breast
There are great developments currently taking place in the field of nerve reconstruction to the breast after mastectomy. We hope to keep you apprised of those developments. Please note it is paramount to find a surgeon who performs nerve reconstruction frequently and with great success. Patients should inquire about this with their plastic surgeon during the initial consult for breast reconstruction.
Listen to the video for an answer to the question: Can sensation be restored to the breast after mastectomy?