American Society for Peripheral Nerve

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Nipple Sparing Mastectomy With Immediate Neurosensitization Of The Nipple Areola Complex
Xiaoti Xu, MD1, Jaime Flores, MD1, Cindy Rodriguez, BS1, Manuel Torres-Salichs, MD2, Jodi Schaefer, RN1, Barbara Ponce, PA1 and Ediledis Tarrio, ARNP3
1Flores Plastic Surgery, Miami, FL, 2Breast Care Center of Miami, Miami, FL, 3Breast Care Center, Miami, FL

Background: Nipple sparing mastectomy (NSM) has been proven to be an oncologically safe technique for treatment of breast cancer. Patients' primary dissatisfaction with the procedure is the loss of nipple areola complex (NAC) sensation. Experience in hand surgery have shown nerve allograft as a successful conduit for nerve repair and good sensory return. Recently nerve allografts have been employed to provide sensate autologous flaps in breast reconstruction to connect intercostal nerves to sensory nerves of autologous flaps. Expanded and novel use of nerve allografts has the potential to preserve NAC sensation after NSM.

Material and Method: At the time of NSM the 4th lateral cutaneous intercostal nerve is identified as it leaves the chest wall and into the breast tissue. At least 1cm of the nerve is dissected from the breast tissue and preserved. The nerve stump is connected to a 7cm nerve allograft using 8-0 nylon. In order reach the NAC, a second 7cm graft is connected to distal end of the graft. Breast reconstruction the proceeds and once completed, prior to skin closure the allograft is routed over vascularized tissue. The individual axons at the end the allograft splayed out and individual axons are sutured into the deep surface of the NAC using 8-0 nylon.

Results: A total of 11 patients underwent NSM and immediate breast reconstruction with direct connection of the NAC. Average age of patients was 49. 4 patients were unilateral mastectomy and 7 were bilateral for a total of 18 breasts with 7 breasts being prophylactic. 2 of the patients had neoadjuvant chemotherapy. 4 patients underwent autologous reconstruction and 7 underwent expander placement with ADM. No complications reported.

Conclusion: Sensation preservation after NSM is a viable option and best performed at the time of mastectomy. Connecting the 4th lateral cutaneous intercostal nerve to the NAC would allow for return of sensation which is often lost. Coordination with breast surgeon is paramount for the identification and preservation of target nerves and success of the procedure. Use of allograft allows the nerve to be connected to the NAC without additional donor site morbidity. The procedure is feasible and does not add increased complication to breast reconstruction. Longer follow up is needed for evaluation of return of sensory function.

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