Sensation of the autologous reconstructed breast improves quality of life: a pilot study

Abstract

Purpose: The number of breast cancer survivors continues to grow. Due to refinements in operating techniques, autologous breast reconstruction has become part of standard care. Impaired sensation remains a debilitating side effect with a significant impact on the quality of life. Microsurgical nerve coaptation of a sensory nerve has the potential to improve sensation of the reconstructed breast. This study investigates the effect of improved sensation of the reconstructed breast on the quality of life in breast cancer survivors.

Methods: A retrospective cohort study was performed in the Maastricht University Medical Center. Patients undergoing a DIEP flap breast reconstruction between January 2015 and January 2016 were included. The primary outcome was quality of life (BREAST-Q domain 'physical well-being of the chest'). The Semmes-Weinstein monofilaments were used for objective sensation measurement of the reconstructed breast(s).

Results: Eighteen patients with and 14 patients without nerve coaptation responded. Nipple reconstruction was the only characteristic that differed statistically significant between both groups (p = 0.04). The BREAST-Q score for the domain physical well-being of the chest was 77.89 ± 18.89 on average in patients with nerve coaptation and 66.21 ± 18.26 in patients without nerve coaptation (p = 0.09). Linear regression showed a statistically significant relation between objectively measured sensation and BREAST-Q score for the domain physical well-being of the chest with a regression coefficient of - 13.17 ± 3.61 (p < 0.01).

Conclusions: Improved sensation in the autologous reconstructed breast, with the addition of microsurgical nerve coaptation, has a statistical significant positive impact on the quality of life in breast cancer survivors according to the BREAST-Q.

Keywords: Breast reconstruction; Nerve coaptation; Neurotisation; Quality of Life; Sensation.

Fig. 1

Anatomical landmarks of the breast for the nine sensation measurement points. The breasts were divided into four quadrants by two lines; line 1 (blue) was drawn from the mid of the clavicle to the nipple; line 2 (green) was drawn perpendicular on line 1. A circle (orange) was drawn around the breast tissue defined by the inframammary and supramammary crease. In each quadrant, a line (black) was drawn at 45°. On the middle of these four lines, sensation was measured. In addition, measurements were done on the areola in each quadrant

Fig. 2

Patient enrolment flow chart

Fig. 3

Linear regression: Relationship between quality of life and sensation in DIEP reconstructed breast. y-axis represents the value of the BREAST-Q domain physical well-being of the chest, values range from 1 to 100: a higher value represents a higher patient satisfaction. x-axis represents a mean monofilament value, which was calculated per patient, if a patient underwent a reconstruction bilaterally one mean value for both breasts was calculated. A scatterplot in which the circles represent the patients with nerve coaptation and the crosses represent patients without nerve coaptation is shown. The black line is the linear regression with a regression coefficient of − 13.17 ± 3.61 and a R ² of 0.31 ± 16.26 (p < 0.01)