Sensation to the breast is important to most women. Nerves in the breast provide this sensation. This feeling provides protection from heat and cold temperatures. The breast is an erogenous zone for several women providing sexual sensation, especially in the nipple and areola area. Nerves are cut at the time of mastectomy when cancerous tissue is removed leaving numbness to the chest. During breast reconstruction, some surgeons perform a procedure using a nerve graft restoring sensation to the breast.
Location of the Nerves Restoring Sensation to the Breast
The breast is comprised of an intricate web of nerves running through the breast tissue. Surgeons tend to speak about the two sides of the breast looking at it from the front. Draw an imaginary line from the arm pit area running down the side. This is the area of the chest referred to as the lateral area. The area at the sternum, or middle of the chest, is called the medial area.
This web of nerves running through the breast tissue are known as the intercostal nerves. Microsurgeons who perform procedures to restore sensation to the breast are trained to look for the tiny nerves in this intercostal area that have been severed during the mastectomy. Often it is the fourth or fifth intercostal nerve used since these are the two running closest to the middle of the breast tissue and toward the nipple areola area. Like a strong branch beginning at the lateral or medial region, tiny branches spread out from this area to make the intercostal nerves. It makes sense then they look for a long, strong “branch” rather than a “tiny twig” to connect together to provide sensation.
What type of Breast Reconstruction can Restore Sensation to the Breast?
Breast reconstruction can be performed with implants or using your own tissue known as autologous reconstruction. There are methods currently being developed for restoring sensation during implant-based reconstruction. However, most nerve sensation is restored during breast reconstruction using a patient’s own tissue, autologous breast reconstruction. Dr. James Craigie points out in the video interview in this blog nerve reconstruction must be performed at the time of autologous breast reconstruction.
The Connecting Nerve from the Flap to the Breast
A healthy nerve must be found in the flap used to create the new breast. Most often this is from the belly tissue as in a DIEP flap breast reconstruction. The nerve has to come with the vascularized healthy tissue as Dr. Craigie states. It takes an extremely skilled and highly trained microsurgeon to identify and match like nerves with similar diameter from the flap to the breast.
For the purposes of this blog, we will discuss DIEP flap so I can relate to my own experience. In a delayed breast reconstruction, a microsurgeon identifies a nerve in the intercostal region. A nerve is harvested from the flap. The nerve found in my intercostal area was long enough and in good enough condition to connect it to the nerve found from my tummy tissue. The surgeon who performed my DIEP flap then did the anastomosis of those two nerves. Anastomosis means to connect the nerves under high powered microscopes.
Bridging the Gap in Nerve Reconstruction
Some patients do not present with a long enough nerve. Additionally, a nerve might be damaged in the breast area after mastectomy. Can sensation be restored in this instance? Yes! Dr. Craigie explains nerves can heal or regenerate across the area that was divided even under these circumstances. When a bridge is needed to help that gap, a nerve graft is used. This graft is “sensory” from a cadaver so no human elements are taken out of it and becomes the structure and framework through which the nerve can grow.
We will discuss the registry being developed to document and improve patient outcomes in a follow up blog. Readers will be able to understand the data being collected by plastic surgeons across multi-center practices who are using the nerve graft and restoring sensation to the breast. I will also explain the progress and time it takes to regain sensation in the follow up blog.
Thank you to Dr. James Craigie from the Center for Natural Breast Reconstruction for taking the time to make this video with DiepCFoundation.