2. A Prospective Intra-patient Control Study of Sensory Recovery After Nipple Sparing Mastectomy And Alloplastic Breast Reconstruction

PURPOSE: Breast sensory nerves are often sacrificed during mastectomy, leading to sensory loss. Studies using the BREAST-Q survey have shown that restoring breast sensation after mastectomy and reconstruction can significantly improve patient-reported quality of life. However, sensory nerve regeneration and recovery are notably slow. This study is the first to quantify the degree of tactile sensation recovery relative to baseline over time in patients undergoing mastectomy with immediate alloplastic reconstruction. METHODS: Patients undergoing nipple-sparing mastectomy with immediate tissue expander-based reconstruction without preoperative or postoperative radiation were prospectively identified and tested preoperatively. Neurosensory testing was conducted across nine distinct areas of the breast using a pressure-specified sensory device. One-point cutaneous sensory scores were scaled from 0-100, with higher numbers indicating better sensation. Postoperatively, patients were tested at the following intervals: 0-3 months, 3-6 months, 6-12 months, 12-24 months, and/or 24-36 months. Sensation scores at each time point were compared to preoperative values, with all patients serving as their own controls. Subanalysis was performed for each of the nine areas tested. A paired t-test (α=0.05) was used for statistical analysis. RESULTS: Overall, 41 patients and 61 breasts were included in the study. The average age and body mass index were 49.8 years and 25.6 kg/m² respectively. The percentage of tactile sensation recovery compared to baseline at various postoperative time points, with darker areas on the heat map representing better sensation. Sensation recovery progressively increased over time, starting at 33.2% of baseline in the first year (p < 0.0001), rising to 54.7% by the second year (p = 0.003), and reaching 63.3% by the third year (p = 0.003). The outer medial area showed the highest degree of sensation recovery at 78.1% of baseline by 24-36 months, with no statistical difference from preoperative scores (p = 0.09). This was followed by the inner medial region (69.5%), outer superior region (69.4%), and inner superior region (68%). The nipple-areola complex exhibited the lowest degree of recovery, reaching 46.6% of baseline by 24-36 months (p = 0.007). CONCLUSION: Our findings can guide preoperative counseling for patients planning to undergo mastectomy with alloplastic reconstruction. They can expect to regain approximately 33%, 55%, and 63% of their preoperative sensation by one, two, and three years postoperatively, respectively.