Back to 2012 Annual Meeting Program
Radiation Affects Sensory Recovery in the Reconstructed Breast
Gedge D. Rosson, MD; Michael Magarakis; Raghu Venkat; A. Lee Dellon; Michele A. Manahan; Justin Ballamy; Elbert E. Vaca; Stacie Jeter
Johns Hopkins University School of Medicine, Baltimore, MD, USA
PURPOSE: Return of sensation after breast reconstruction in patients that had undergone radiation therapy with or without concomitant flap neurotization have not been thoroughly studied. Thus we sought to evaluate the effect of radiation therapy upon long-term recovery of sensation after breast reconstruction with both autologous perforator flaps and implant-based techniques.
METHODS: 37 patients (74 breasts) were included, with a minimum post-operative interval of 18 months. There were 27 deep inferior epigastric artery perforator (DIEP) flaps and 29 implant-based reconstructions (plus 18 non-reconstructed breasts). 11 implants and 10 DIEP flaps had pre-reconstruction radiation therapy. The primary outcome was mean static and moving cutaneous pressure threshold, measured with the Pressure-Specified Sensory Device (PSSD) in 9 areas of the breast. Six of the DIEP flaps were neurotized with a medial intercostal nerve, and four of these six did not receive radiation therapy. Formal IRB approval was obtained.
RESULTS: Multivariate analysis adjusting for BMI, chemotherapy, time since surgery and timing of reconstruction (immediate, staged or delayed), while accounting for within person correlations, demonstrated that radiation therapy negatively affected sensory recovery among implant-based reconstructions (static, p=0.002; moving, p=0.014), and that, in the absence of radiation, implants were associated with better sensation (static, p<0.0001; moving, p<0.0001) than DIEP flaps. On the other hand, in the presence of radiation therapy, non-neurotized DIEP flaps, were associated with a better sensation recovery than implants (static, p=0.003, moving, p=0.006). Radiation therapy, independently, was found to negatively affect sensation recovery among implant-based reconstructions (static, p=0.002; moving, p=0.014). A subgroup analysis of DIEP flaps (neurotized [n=6] vs non-neurotized [n=21]) showed that in the absence of radiation, neurotization was associated with better static (60.6 gm/mm2 vs 77.2 gm/mm2) and moving (30.9 gm/mm2 vs 59.2 gm/mm2) sensation in the DIEP flap skin island. Nipple-sparing mastectomy (n=3) trended to positive effect on sensation recovery in implant-based reconstruction.
CONCLUSION: In the absence of radiation, skin territories overlying implants are associated with a better sensation recovery than DIEP flap skin. However, with prior chest radiation, the non-radiated DIEP flap skin island had a better sensation recovery than the radiated skin overlying the implants. Neurotization appeared to improve sensation in DIEP flaps.
Back to 2012 Annual Meeting Program