Sensory Restoration With Breast Reconstruction: Approaches, Managing Expectations, and Measuring Outcomes.

Abstract

Background: Loss of breast sensation following mastectomy and reconstruction significantly impacts quality of life, influencing body image, intimacy, and overall emotional well-being. Despite advances in reconstructive techniques, sensory outcomes remain inconsistent, limiting broader clinical adoption of reinnervation strategies. This educational review synthesizes the current scope of sensory restoration in breast reconstruction, examining approaches to reinnervation, sensory outcome measures, and management of patient expectations.

Methods: The existing literature on breast reconstruction was reviewed along with evidence on nerve repair more generally to evaluate current microsurgical techniques and identify research gaps. Data extracted included quantitative outcomes, such as Semmes-Weinstein monofilament testing and 2-point discrimination, as well as qualitative or patient-reported outcome measures like BREAST-Q or VMP-B scores. Statistical analyses were performed using R software version 4.4.1.

Results: Innervated deep inferior epigastric perforator (DIEP) flaps and targeted nerve grafting serve as promising techniques, achieving improved tactile recovery in both objective and qualitative measures. However, variability in long-term recovery, the diminishing returns of meaningful recovery in longer nerve grafts (R2 = 0.986), and their impact on quality-of-life metrics remain underexplored. Moreover, the inconsistent sensory outcomes heighten the need for psychosocial support to manage patient expectations.

Conclusions: Longitudinal studies emphasizing innovative grafting strategies and integration of emerging technologies including bioengineered nerve conduits and regenerative therapies offer exciting opportunities to enhance sensory recovery. Advancing sensory restoration in reconstructive breast surgery requires a patient-centered approach to inform surgical practice by aligning clinical enthusiasm with robust evidence, ensuring meaningful and rigorous improvements in functional and emotional outcomes.