DiepCFoundation interviews Dr. Minas Chrysopoulo from PRMA in San Antonio about sensory nerve reconstruction during DIEP flap after mastectomy to restore sensation to the breasts. The procedure is called microneurorrhaphy (micro-ner-ar-o-fee) A real mouth full!
Dr. C points out that this is a complex topic to describe at a consult. A plastic surgeon may say that your breasts will “feel” more natural but “to whom”? The reality is that the patient will not feel the same that they did before mastectomy.
I am the Founder and Director of DiepCFoundation and was fortunate to have this interview with Dr. Chrysopoulo. I am also a patient who has had successful sensory nerve repair performed by Dr. C. It is truly better than the alternative, which is NO sensation in the breasts at all. I’m quite used to this “new” sensation now and I like it. I feel very fortunate to have found a microsurgeon who routinely and successfully performs this procedure.
Sensation in the breasts is often an important component of sexual intimacy for women. Women discuss this with me before they have DIEP flap breast reconstruction. I simply tell them that they will have to guide their partner to the new area of sensation in their reconstructed breasts. It is a difficult topic to discuss at a consult, but I encourage patients to bring it up.
Who does sensory nerve reconstruction?
- It requires a microsurgeon to perform this delicate procedure.
- Not all microsurgeons perform sensory nerve repair.
What we know after mastectomy.
- Mastectomy leads to numbness of varying degrees because nerves are cut.
- Overtime, after mastectomy, some feeling may return but not in all instances.
- That sensation, if it returns, will begin at the base of the breast on the side moving toward the nipple/areola complex.
- Patients who have had a skin sparring, nipple sparring mastectomy (NSM) have a better chance of some sensation returning.
When is sensory nerve reconstruction performed?
- It is only performed during autologous breast reconstruction: DIEP flap, SIEA flap, and some other selective autologous flaps depending on where the tissue comes from.
- Implants don’t improve sensation because there is nothing about implants that encourage nerves to regrow since implants are a man-made object.
- Using your own tissue, however, will result in better and some restored sensation during breast reconstruction.
- Sensory nerve reconstruction on a radiated side may not be as successful due to compromised tissue and blood flow from the radiation.
- Studies are being done to explore the effects of radiation to improve outcomes during sensory nerve reconstruction.
How is sensory nerve reconstruction performed?
- In DIEP flap breast reconstruction, a nerve that supplies skin to part of the tummy flap is identified.
- That nerve is then transferred along with the tummy flap up to chest area.
- A nerve in the chest area, preferably the 4th intercostal nerve, that was cut during mastectomy is identified.
- The nerve found in the tummy tissue is then attached to the cut end of the 4th intercostal nerve.
- Why intercostal? When a microsurgeon looks, finds, and prepares blood vessels in the chest, that are used to connect blood vessels from the flap, the nerves travel near those blood vessels.
- THAT is the intercostal space!!!
The reality is that not all microsurgeons perform this procedure, but don’t you think it’s worth asking the question and seeking a plastic surgeon who does perform it? It was worth it for me to travel 800 miles to have it done. With planning, it’s possible.
Thank you to Dr. Minas Chrysopoulo for an explanation that was patient friendly. This will hopefully allow the viewer to better understand sensory nerve reconstruction and know that some sensation can be restored after mastectomy.