Degree and Timing of Sensory Return Following Nipple-Areolar Complex Neurotization During Nipple-Sparing Mastectomy.

Abstract

Traditional expectations around sensation following nipple-sparing mastectomy include significant or often complete sensory loss of the nipple-areolar complex. Nipple neurotization at the time of mastectomy has proven promising in restoring sensation to the area postoperatively. However, minimal data are available on the degree and timing of sensory return following neurotization. Forty-seven patients (representing 94 breasts) underwent nipple-sparing mastectomy (NSM) with direct-to-implant, prepectoral reconstruction. During the mastectomy, branches of the T4 and T5 lateral intercostal nerves were identified and dissected to preserve length before transection was required oncologically to complete the mastectomy. The nerves were then reconstructed using a nerve allograft or autograft with coaptation to an identified subareolar nerve. Neurosensory testing with a pressure-specified sensory device was performed at several time points postoperatively to quantify return of sensibility. Patients were also given modified BREAST-Q questionnaires at similar time points to assess their perception of sensation return. Nipple sensation decreased markedly in the early months after mastectomy and then slowly returned to baseline by 1 year postoperatively, with 74% of patients achieving pressure-specified sensory device results in the excellent range by 12-month testing. Overall, patients having bilateral risk-reducing mastectomy achieved higher rates of nipple sensory return at 1 year than those having mastectomies as part of cancer treatment. On patient-reported outcomes, 53% of patients reported having a lot or some nipple sensation by 6 months postoperatively, which increased to 70% by 1 year. Ninety-two percent of patients reported responsiveness to touch in their nipples at the 12-month postoperative time point. Nipple-areolar complex neurotization allows for return to baseline nipple sensation on quantitative testing by 1 year postoperatively for the vast majority of patients undergoing the procedure. Similar results are seen for patient-reported outcomes on overall nipple sensation and responsiveness to touch. As adoption of sensation preserving mastectomy techniques becomes more widespread, further investigation into optimal assessment tools and protocols will continue to improve understanding of outcomes and help with patient expectation setting.