SRS137 - Targets for nipple-areolar complex sensory preservation during mastectomy

Abstract Background Preservation of nipple-areolar complex (NAC) sensation post-mastectomy improves breast cancer survivorship. Recent data from robotic nipple sparing mastectomy (rNSM) series have demonstrated excellent post-operative NAC sensation preservation; however, anatomical data underpinning the improvements in sensory outcomes are lacking. Aim To identify possible nerve targets suitable for preservation during mastectomy and produce a renewed anatomical map of NAC sensory innervation. Methods Dissection of six cadaveric embalmed female breasts was performed. Nerves were traced and photographed from their intercostal nerve (ICN) origin, through musculo-fascial planes, to their termination at the NAC. A literature review, using a modified-PRISMA approach, was undertaken. Results The NAC is predominantly supplied by the 4th ICN, via both anterior cutaneous and lateral cutaneous branches (ACB, LCB). The 4th ICN LCB travels deep through the glandular tissue of the breast, likely rendering it an unsuitable target for preservation. Conversely, the superficial 4th ACB arises parasternally and travels subdermally to the NAC, thus representing a more favourable target for preservation, and possibly explaining the improved sensory outcomes seen in rNSM, given its lateral approach. Other non-dominant contributions were provided by 3rd and 5th ICN, however, significant anatomical variability was observed. Conclusions This study lays a foundational anatomical basis for NAC sensory preservation observed in rNSM and identifies targets for nerve preservation applicable to both nipple sparing mastectomy, whether robotic or open. Further research is needed to verify and expand on these anatomical findings, and to establish operative techniques aimed at preserving sensation while maintaining oncologically complete resections