Targeted Nipple Areola Complex Reinnervation: Technical Considerations and Surgical Efficiency in Implant-based Breast Reconstruction

Abstract

Background: Despite promising pilot study results, adoption of neurotization of immediate implant-based reconstructions has not occurred.

Methods: For surgeons interested in adopting breast reinnervation techniques, we present ways to overcome initial barriers by decreasing operative time and maximizing chances of sensory recovery.

Results: We discuss the combined experience at two academic teaching hospitals, where neurotization of both immediate tissue expander cases and direct-to-implant reconstructions are performed through varying mastectomy incisions.

Conclusion: Initial barriers can be overcome by shortening operative time and providing an individualized reinnervation approach that aims to increase the chance of meaningful sensation.

Fig. 1.

Lateral cutaneous nerve dissection. A, The fourth intercostal nerve (white arrow) has been identified at the lateral border of the pectoralis muscle. B, The third to fifth intercostal nerves (white arrows) are dissected out and transected.

Fig. 2.

TNR: separation of the nerve allograft to increase the reinnervation zone. A, The distal allograft is carefully split into its fascicles and (B) attached the dermatosensory peripheral nerve fibers of the NAC. B, After nipple-sparing mastectomy, all the breast tissue is removed from underneath to the NAC. At this level, it is very difficult to differentiate small nerve endings from nipple ducts without sending a frozen section.