Many women are left numb after mastectomy. At PRMA in San Antonio, Texas they have created the term TruSense℠ that refers to restoring sensation and wholeness after breast cancer surgery. I interviewed Dr. Minas Chrysopoulo to learn why this procedure is important to patients.
Maintaining Breast Sensation after Breast Cancer Surgery
Dr. Chrysopoulo, Dr. C to his patients, points out the good news first. We now have surgical techniques where there are ways of maintaining sensation and even restoring it. There are variations in mastectomy results. The breast surgeon has a lot to do with how much feeling they have after mastectomy. Thus, this is a breast surgeon issue since they are the ones removing the breast gland that contain the nerves that provide feeling. Dr. C points out they do not do it on purpose it is just the way the nerves travel through the breast tissue. There are circumstances when the nerves cannot be preserved.
Therefore, it is important to find a breast surgeon who is willing to have a conversation about preserving those nerves and if it is possible to do so. To find out more about this please listen to the DiepCJourney podcast episode with Dr. Chrysopoulo and a leading expert in nerve preservation, Dr. Anne Peled. It goes into in depth detail about nerve preserving mastectomies with Dr. Peled. At PRMA, Dr. C shares they work with selective breast surgeons who perform nerve preserving mastectomies for their patients.
Restoring Sensation to the Breast After Mastectomy
When Dr. C performs DIEP flap surgery with his colleagues, they reconstruct nerves that have been cut. Through the TruSense℠ approach they connect these cut nerves and reconnect the cut nerve to tissue that can regain feeling. Because they focus on tissue based reconstruction at PRMA, the benefit is that tissue has the ability to restore feeling that implants do not have.
DIEP flap is the most common type of tissue reconstruction. Dr. C explains during this type of breast reconstruction, they take a nerve in the abdominal area they find in the tissue. This tissue from the belly, along with the nerve is then transplanted to the breast area where they reconnect a nerve that’s been cut in the breast during a mastectomy. The nerve that used to supply feeling to the tummy tissue can now supply feeling to the breast.
Methods of Connecting Nerves to the Breast
Dr. C points out the methods used to connect the nerves once the belly tissue is transplanted to the breast area. He tells us they connect them “end to end” using a few sutures under a high-powered microscope. This is referred to as a “direct” nerve repair.
Sometimes the two nerves don’t reach each other. This may be due to the way the flap is positioned, or because it’s a short nerve. In these instances, Dr. C states they use an extra piece of nerve from the patient or a nerve graft to bridge the gap. In the video he actually show a remnant of a patient’s nerve they did not need so they saved it and repurposed this extra piece of nerve to connect two nerves together at the chest. I smile and say, “Waste not, want not”! The “shelf” nerve grafts that PRMA currently use is a product from Axogen. The term used by Axogen to restore sensation is known as Resensation®.
Breast Sensation Terminology
A quick rundown of terms that can often become confusing to patients in discussion at a consult or in online forums is briefly outlined here.
- Nerve preservation: Saving the nerves at the time of mastectomy.
- Nerve reconstruction: In our conversation in this blog this is TruSense℠ or connecting the nerves without using an off the shelf nerve graft.
- Resensation®: Using a cadaveric product from Axogen.
TruSense℠ refers to restoring sensation, true, natural restoration using:
- The patient’s own tissue
- The patient’s own nerves
- Nothing foreign
Why Restoring Sensation is Important to Patient Safety
The embedded video will give our readers a greater understanding of the process. What I am disappointed in, but understand, is YouTube cut our video short due to their guidelines. Dr. C showed a slide with a patient who sustained a thermal injury to reconstructed breasts after using a warming device. The lack of sensation is not only important to patients for erogenous reasons. It is also for their safety as is discussed in this PRS Global Open paper. I caution the reader as it does show a graphic photo of the burned breast. This is the slide taken down by YouTube that Dr. C used before our video was cut short. Because there is an age restriction, please log into your YouTube account to watch it.
Our call to action for breast surgeons is to consider performing nerve preservation surgery when it is possible and oncologically safe for patients. We share a similar call to action for microsurgeons. You have been trained to connect blood vessels. We ask you to add nerve reconstruction to your armamentarium. We feel your patients will appreciate your attempt to do so. I also ask patients to ask about restoring sensation to the breast after breast cancer surgery. As always, thank you for your time and expertise Kind Sir discussing TruSense℠ and restoring sensation!