Health Matters 9/18: Innovative Surgical Technique Can Restore Sensation After Mastectomy

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By Evan Katzel, M.D.

Reconstructive surgery after a mastectomy to treat breast cancer is increasingly common among women in the United States, according to the American Cancer Society.

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With the rebuilding of the shape and look of their breast, many women regain their self-image, self-confidence, and quality of life after cancer treatment.

Yet until recently, breast reconstruction surgery could not restore sensation, leaving women with a numb breast for the rest of their lives.

Today, however, patients at Penn Medicine Princeton Health have the option of reconstructive surgery that uses their own to tissue to recreate the breast and reconnects the nerves that supply sensation, helping women to look and feel more like themselves.

Alternative to Implants

The American Cancer Society estimates that more than 276,000 new cases of invasive breast cancer will be diagnosed in women throughout the United States this year. Breast cancer is a leading cause of cancer in American women, second only to several types of skin cancer.

Many women will choose to undergo some form of mastectomy – the surgical removal of the breast – as part of their treatment program and will opt for reconstructive surgery.

While the most common form of reconstructive surgery uses artificial breast implants, women seeking an alternative have the option of a procedure called the Deep Inferior Epigastric Perforator Flap (DIEP) or free flap procedure, which uses the patient’s own living tissue to replace the breast tissue removed in a mastectomy.

During the procedure, a flap of tissue is removed from the abdomen similar to the area removed during a tummy tuck, and that flap is shaped to recreate the breast. The flap contains skin, fat, and blood vessels that bring healthy tissue and blood supply to the affected area.

Little or no muscle is taken from the abdomen, and by using the patient’s own tissue, the reconstructed breast incorporates naturally with surrounding tissue.

Restoring Sensation

Surgeons performing the free flap procedure may also use an innovative surgical technique that can restore sensation to the breast tissue.

This technique, a nerve graft, reconnects one of the nerves that supply sensation to the chest to one of the sensory nerves in the free flap tissue.

Once the nerve has regenerated, which typically takes between nine months and a year, patients may experience the return of some degree of sensation in the new breast.

It is important to note that patients who have had the nerve graft procedure will require an anesthetic during nipple reconstruction because they will feel some sensation and pain. Most nipple reconstruction procedures occur between six months and one year after breast reconstruction surgery.

While a longer and more complex surgery, a free flap procedure with the nerve graft leaves patients with a natural looking and feeling breast, as the tissue will change as the body changes.

Natural Looking and Feeling

Studies have shown that the risk of infection, hospital readmission and future revision surgeries are reduced with the free flap procedure. Additionally, improved blood supply provided by the transferred tissues also helps the healthy tissue respond better to the effects of radiation treatments.

Free flap reconstruction can also reduce future visits to the doctor, and a patient can have the procedure at the same time as their mastectomy or as a delayed procedure any time after a mastectomy. Patients who have had prior breast implant-based reconstruction and are not fully satisfied are also candidates for the flap procedure.

The procedure is well tolerated by many patients. Generally, if a patient is approved to undergo anesthesia, they can be cleared for the flap procedure. Any patient undergoing the free flap procedure is a candidate for the nerve graft.

The free flap nerve graft procedure is part of the comprehensive breast reconstruction program at Penn Medicine Princeton Health. Federal law mandates that all insurances must cover any post-mastectomy breast reconstruction.

Highly Personal Decision

The decision to have breast reconstruction surgery is highly personal.

If you are considering this procedure, talk with your doctor and with a plastic surgeon that is experienced in breast reconstruction prior to your mastectomy so you can understand all of your options.

Together with your doctors, you can plan the best treatment approach to meet your unique goals.

For more information or to find a physician with Penn Medicine Princeton Health, call 1-888-742-7496 or visit www.princetonhcs.org.

Evan Katzel, M.D., specializes in microvascular plastic surgery and is a member of the medical staff at Penn Medicine Princeton Health.

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