Dermatology & Plastic Surgery Institute Outcomes
Reconstructive Surgery
Breast Sensation Recovery After Neurotized Deep Inferior Epigastric Perforator Reconstruction
To evaluate breast sensation outcomes after combined nerve conduit and allograft in deep inferior epigastric perforator (DIEP) reconstructions, Cleveland Clinic surgeons performed sensation recovery tests in patients who underwent DIEP reconstruction with neurotization. A total of 74 patients (96 breasts) underwent this technique between June 2016 and December 2018. Thirty-eight patients (61 breasts) underwent sensory testing. Among these breasts, 46 had neurotization (group 1) and 15 did not (group 2). Group 1 achieved better sensory thresholds in 56.25% of total areas evaluated, compared with group 2. In the second round of sensation tests, the clinical difference between the groups was more evident with better sensation thresholds in all areas tested for the neurotized group. Thresholds on the first and second tests were statistically similar. There is a positive trend for breast sensation recovery after reconstruction with neurotized DIEP flaps.
Patient Demographics and Clinical Characteristics of Groups 1 and 2 (N = 61)
June 2016 – December 2018
| Characteristic | Neurotization 75.4% (N = 46) | No Neurotization 24.6% (N = 15) | P |
| Age (µ ± SD) | 49.9 ± 9.5 | 49.4 ± 9.3 | 0.842 |
| BMI (µ ± SD) | 29.5 ± 3.9 | 28.5 ± 3.8 | 0.367 |
| Specimen Weight (µ ± SD) | 668.2 ± 246.5 g | 542.8 ± 211.4 g | 0.1 |
| Smoking History, % (N) | 0.833 | ||
| Never smokers or history < 1y | 69.6 (32) | 66.7 (10) | |
| Smoking history > 1 year | 30.4 (14) | 33.3 (5) | |
| Comorbid Conditions, % (N) | |||
| Hypertension | 15.2 (7) | 13.3 (2) | 0.858 |
| Diabetes mellitus | 4.35 (2) | 0 (0) | 0.412 |
| Clotting disorder | 2.2 (1) | 6.7 (1) | 0.396 |
| Thyroid disorder | 17.4 (8) | 13.3 (2) | 0.712 |
| Dyslipidemia | 13.04 (6) | 20.0 (3) | 0.509 |
| Depression | 17.4 (8) | 40.0 (6) | 0.071 |
| Anxiety | 17.4 (8) | 26.7 (4) | 0.433 |
| Radiation Therapy, % (N) | 30.4 (14) | 46.7 (7) | 0.251 |
| Percent prior to nerve surgery | 100 (14) | 85.7 (6) | 0.147 |
| Prophylactic Procedure, % (N) | 41.3 (19) | 46.7 (7) | 0.715 |
| Type of Mastectomy, % (n) | 0.166 | ||
| Skin-sparing mastectomy | 67.4 (31) | 53.3 (8) | |
| Nipple-sparing mastectomy | 32.6 (15) | 40.0 (6) | |
| Postoperative Complications, % (N) | |||
| Delayed wound healing | 21.7 (10) | 6.7 (1) | 0.187 |
| Seroma | 4.4 (2) | 0.0 (0) | 0.412 |
| Hematoma | 2.17 (1) | 0 (0) | 0.565 |
| Reoperation required, % (N) | 32.6 (15) | 26.7 (4) | 0.666 |
| Greater than 1 reoperation required * | 53.3 (8) | 25.0 (1) | 0.313 |
Comparison of Test 1 Outcome Between Groups 1 and 2 (N = 61)
June 2016 – December 2018
Comparison of Test 1 Outcomes Between Groups 1 and 2 (N = 61) | Neurotization (N = 46) | No Neurotization (N = 15) | P |
|---|---|---|---|
| Length of Time Between Surgery and Test 1 (µ ± SD) (Months) | 10.0 ± 5.7 | 9.6 ± 5.5 | 0.604 |
| Threshold: Mastectomy Skin Sensation (µ ± SD) | 70.4 (23.3) | 72.7 (34.0) | 0.808 |
| Superior | 65.4 (33.3) | 64.1 (33.5) | 0.896 |
| Medial | 63.5 (33.1) | 60.2 (35.5) | 0.682 |
| Inferior | 73.3 (29.7) | 62.8 (33.5) | 0.825 |
| Lateral | 73.9 (29.8) | 74.9 (27.9) | 0.907 |
| Upper outer quadrant (UOQ) | 32.2 (30.5) | 38.16 (31.5) | 0.6 |
| Upper inner quadrant (UIQ) | 29.1 (25.9) | 28.4 (32.7) | 0.941 |
| Lower outer quadrant (LOQ) | 55.1 (39.0) | 53.6 (34.1) | 0.556 |
| Lower inner quadrant (LIQ) | 35.9 (31.2) | 39.0 (30.9) | 0.74 |
| Threshold: Skin Flap Sensation (µ ± SD) | 83.6 (19.6) | 86.5 (23.9) | 0.729 |
| Superior | 81.9 (25.6) | 90.8 (24.4) | 0.333 |
| Medial | 80.8 (23.4) | 74.4 (35.1) | 0.597 |
| Inferior | 88.1 (19.7) | 89.5 (25.6) | 0.877 |
| Lateral | 83.5 (23.3) | 91.3 (24.9) | 0.393 |
| Upper outer quadrant (UOQ) | 69.0 (32.4) | 69.7 (35.2) | 0.961 |
| Upper inner quadrant (UIQ) | 59.9 (32.9) | 59.9 (34.5) | 0.999 |
| Lower outer quadrant (LOQ) | 58.8 (31.8) | 85.1 (25.9) | 0.031 |
| Lower inner quadrant (LIQ) | 55.3 (30.5) | 67.9 (32.3) | 0.318 |
Comparison of Sensation Thresholds in Skin Flap (Neurotized Group) Between Test 1 and 2 (N = 56)
June 2016 – December 2018
UOQ = upper outer quadrant, UIQ = upper inner quadrant, LOQ = lower outer quadrant, LIQ = lower inner quadrant
Comparison of Sensation Thresholds in Mastectomy Skin (Neurotized Group) Between Test 1 and 2 (N =56)
June 2016 – December 2018
UOQ = upper outer quadrant, UIQ = upper inner quadrant, LOQ = lower outer quadrant, LIQ = lower inner quadrant
