Breast neurotization along with breast reconstruction after nipple sparing mastectomy enhances quality of life and reduces denervation symptoms in patient reported outcome: a prospective cohort study.

Abstract

Objective: Persistent postoperative sensory loss significantly limits breast reconstruction following mastectomy. In addition, the absence of sensation profoundly impacts patients' physical well-being and overall quality of life. New surgical techniques involving nerve autograft intercostal nerve elongation have been introduced to neurotize reconstructed breasts. However, patient quality of life after neurotization has not been well evaluated. This study aimed to investigate improvements in patient quality of life in association with breast neurotization.

Methods: A prospective cohort study of 132 patients treated at (blinded for review) between January 2018 and December 2022 was conducted. Two groups of patients who underwent nipple-sparing mastectomy (NSM) and breast reconstruction were compared: those with (n = 67) and without (n = 65) breast neurotization. Patient-reported outcomes were assessed via the BREAST-Q reconstruction module questionnaire and an additional questionnaire measuring sensation, nipple satisfaction, and breast symptoms. Objective measurements were conducted via the Semmes-Weinstein monofilaments test.

Results: With respect to patient-reported outcomes, the innervated group had significantly higher scores for nipple sensation and on the BREAST-Q domains of psychosocial well-being (71.6 ± 18.1 vs. 62.8 ± 18.6, P = 0.006), sexual well-being (56.9 ± 22.1 vs. 47.3 ± 20.7, P = 0.015), satisfaction with the medical team, as well as less frequent post-operative breast symptoms. In the subgroup analysis, the innervated group demonstrated higher scores in both autologous flap and implant-based reconstruction. Linear regression revealed a statistically significant relationship between objectively measured monofilament value and subjectively examined patient-reported outcomes: nipple sensation, breast sensation, and BREAST-Q score for the psychosocial well-being domain (coefficient: - 4.922, P = 0.033).

Conclusion: Breast reconstruction with autologous nerve graft neurotization yields improved sensory outcomes and has a statistically significant positive impact on the quality of life of breast reconstruction patients.