Sensory reinnervation after mastectomy with implant-based reconstruction

As breast cancer therapies continue to improve, increasing focus has been placed on quality-oflife issues after breast cancer and breast cancer risk-reducing treatments. The loss of sensation that typically occurs after mastectomy can have significant negative psychological, sexual, and functional impact on patients after surgery. In order to minimize this impact, more recent attention has been paid to ways to both avoid nerve injury at the time of mastectomy and reconstruct injured nerves either during mastectomy or at the time of delayed reconstruction. These advances have been facilitated by anatomic studies investigating different variants of intercostal anatomy and better understanding the course of the nerves innervating the mastectomy skin and nipple-areolar complex. With improved knowledge of the intercostal nerve anatomy, surgeons are able to carefully preserve nerves at the time of mastectomy, thus improving sensory outcomes. Additionally, nerve reconstruction techniques have advanced, particularly with newer nerve allograft technologies, which allows for nerve reconstruction to be done both at the time of mastectomy, as well as in a delayed fashion. Much of the current literature on intercostal nerve reconstruction to improve postmastectomy sensation has been performed in the setting of autologous reconstruction, but several more recent studies have assessed outcomes following implant-based reconstruction. The focus of this article is to describe the current state of sensory preservation and reinnervation for mastectomy with implant-based reconstruction and the advances that have allowed for these new approaches.