In Episode 3 of the DiepCJourney podcast I discuss breast reconstruction and breast sensation with two surgeons who have performed this procedure together in their practice. Dr. Anne Peled and Dr. Ziv Peled work in tandem in the operating room to preserve and restore sensation to the breast for those affected by breast cancer.
The paper published by Dr. Anne and Ziv Peled can be found in the PRS Global Open under the title,
PRS Global Open
Dr. Anne Peled, who was diagnosed with breast cancer herself, was torn about what surgical option to choose for her own diagnosis; a lumpectomy, oncoplastic surgery or mastectomy. She was aware, due to standard training of breast surgeons, a mastectomy would mean the likelihood of losing sensation to her breasts. Most patients who undergo mastectomy are left numb and as she states, if you got any sensation back you were just lucky.
Ideas and Innovations in Breast Sensation
Anne chose to have a lumpectomy and oncoplastic surgery. That was in mid-January of 2018. She and her husband Ziz began the discussion about how they could preserve nerves at the time of implant reconstruction. By the end of February 2018, just a short time after her own breast surgery, together they performed their first nerve preservation surgery with implant reconstruction.
They built their idea on the innovation and success of microsurgeons who had been doing nerve reconstruction for a number of years at the time of flap reconstruction. Nerve reconstruction during flap surgery, like DIEP flap, involves reconstructing nerves that are cut during mastectomy. The microsurgeon finds a nerve in the abdominal area and transfers it with the tissue and blood vessels connecting it through anastomosis to a nerve in the breast area. Women gain sensation back in varying degrees in the breast area with this procedure over time. Although the sensation varies with patients, they often feel that some sensation is better than being left numb.
Challenges Faced at the time of Breast Reconstruction Surgery to Restore Sensation
Dr. Ziv Peled points out patients’ anatomy can vary. Looking for nerves that are exceedingly small, many under a mm in diameter, is challenging. Given the conventional approach to mastectomy, surgeons have not historically been trained to look for these small nerves along the breast area and anatomy of innervation, sensory input to all the structure of the breast that includes skin and the nipple areola complex. Dr. Anne and Ziv Peled hope to do more training of surgeons to look for these nerves at the time of mastectomy so more patients have access to this procedure.
Many factors can change the anatomy of the breast area and thereby compromise and make more difficult the dissection of the nerves. Factors may include prior surgery or radiation to the breast area causing scarring and damage to the nerves. The health of the patient is of utmost importance and must be considered at the time the tumor is removed, another factor making the dissection of nerves for breast sensation more difficult.
Measuring Breast Sensation after Breast Reconstruction
In this Ep. 3: Breast Reconstruction and Breast Sensation, Dr. Ziv Peled mentions the term neuroplasticity and adapting to the new changes and feelings as our brains sense these feelings. In breast reconstruction and restoring breast sensation, these feelings are measured after surgery with a touch test to determine how much pressure is needed to sense touch to the breast after surgery. The collection of this data will be used to make continual improvements to this type of nerve preservation surgery moving forward.
Nerve Preservation vs. Nerve Reconstruction
To recap, nerve preservation is done at the time of mastectomy. The hope is this method to preserve breast sensation can be done in a cooperative manner between the breast surgeon and the plastic surgeon. There is work to be done in this area so that this process becomes more the norm than the exception.
Nerve reconstruction is done after a mastectomy by a microsurgeon who performs reconstructing nerves that have already been cut. The nerve is reconstructed using a nerve found in the abdominal area and transferred with the tissue and blood vessels to the breast area to regain new sensation to a breast left numb after a mastectomy. This can only be done at the time of autologous breast reconstruction and not at a later time.
Ep. 3: Breast Reconstruction and Breast Sensation
You can listen to Episode 3: Breast Reconstruction and Breast Sensation on the DiepCJourney podcast by clicking on the link below. Ask your surgeon about this procedure. Discussing it and making other patients and surgeons aware of the possibility of breast sensation at the time of breast reconstruction will drive change.