Comparing Primary Coaptation and Allograft in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: Long-Term Sensory and BREAST-Q Outcomes.

Abstract

Background: Loss of breast sensation after mastectomy and breast reconstruction is associated with decreased psychosocial outcomes and quality-of-life, spurring applications of peripheral nerve repair to autologous breast reconstruction. While direct nerve coaptation is the gold standard for neurotization, the development of nerve allografts has increased candidacy for neurotization. Herein, we investigate long-term sensory and BREAST-Q outcomes in patients receiving deep inferior epigastric perforator (DIEP) flap reconstruction neurotized by direct coaptation and nerve allograft.

Methods: Patients with neurotized DIEP reconstruction with direct coaptation or nerve allograft were retrospectively identified and invited to undergo breast sensation testing with a pressure-specified sensory device. Patients also completed the Reconstruction and Breast Sensation modules of the BREAST-Q questionnaire.

Results: 30 patients (53 flaps) were included in this study, with 18 flaps reconstructed with direct nerve coaptation and 35 flaps reconstructed with an allograft. The overall breast cutaneous sensitivity measurement was 64.58 g/mm2 [40.06, 78.99] in the direct coaptation group and 78.28 g/mm2 [40.60, 82.06] in the nerve allograft group, with no significant differences overall (P = 0.680) or at any specific breast area. BREAST-Q surveys were completed at an average follow-up time of 94.42 months in the direct coaptation group and 61.56 months in the allograft group. The two groups had comparable scores for all survey scales (P > 0.05).

Conclusion: DIEP flaps neurotized by direct coaptation and nerve allograft have comparable long-term objective and patient-reported breast sensation. Nerve grafting is a viable alternative for patients who are not candidates for direct end-to-end nerve coaptation.