Breast reconstruction by means of innervated rectus abdominis myocutaneous flap.

Abstract

We performed immediate breast reconstruction in 22 patients using rectus abdominis myocutaneous flap accompanied by neurorrhaphy in the past 2 years. In the neurorrhaphy, the 11th intercostal nerve, which controls the sensation of the myocutaneous flap, was anastomosed to the lateral cutaneous branch of the 4th intercostal nerve, which controls the sensation of the breast. Our study included 15 patients, and the postoperative follow-up period was 4 to 24 months, with an average of 14.0 months. For control subjects, there were 16 cases of rectus abdominis myocutaneous flap, whose sensory nerve had not been reconstructed (postoperative follow-up period 11 to 41 months, average 24.1 months). The sensory examination included tests of touch, pain, and temperature. The innervated myocutaneous flap sensation showed gradual recovery at about 6 months after surgery and reached the value of the normal side after about 1 year. In the control subjects, recovery of sensation was not observed at all in the first 10 postoperative months. Then, after more than 1 year, the recovery was gradual and reached the value of the normal side in only some control subjects. Therefore, we consider the present technique useful for recovery of sensation in immediate breast reconstruction.