title: Breast sensation after breast reconstruction: a systematic review.
abstract: Studies show some return of breast sensation after breast reconstruction; however, recovery is variable and unpredictable. Efforts are being made to restore innervation by reattaching nerves (neurotization). We sought to systematically review the literature addressing breast sensation after reconstruction. The following databases were searched: EMBASE, Cochrane, and PubMed. Additionally, the PLASTIC AND RECONSTRUCTIVE SURGERY journal was hand searched from 1960 to 2009. Inclusion criteria included breast reconstruction for cancer, return of sensation with objective results, and patients aged 18 to 90 years. Studies with purely cosmetic procedures, case reports, studies with less than 10 patients, and studies involving male patients were excluded. The initial search yielded 109 studies, which was refined to 20 studies with a total pool of 638 patients. Innervated flaps have a greater magnitude of recovery, which occurs at an earlier stage compared with the noninnervated flaps. Overall, sensation to deep inferior epigastric artery perforator flaps may recover better sensation than transverse rectus abdominis myocutaneous flaps, followed by latissimus dorsi flaps, and finally implants. Women's needs and expectations for sensation have led plastic surgeons to investigate ways to facilitate its return. Studies, however, depict conflicting data. Larger series are needed to define the role of neurotization as a modality for improving sensory restoration.
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Sachin M
authors.initials: SM
authors.lastname: Shridharani
authors.forename: Michael
authors.initials: M
authors.lastname: Magarakis
authors.forename: Sahael M
authors.initials: SM
authors.lastname: Stapleton
authors.forename: Basak
authors.initials: B
authors.lastname: Basdag
authors.forename: Stella M
authors.initials: SM
authors.lastname: Seal
authors.forename: Gedge D
authors.initials: GD
authors.lastname: Rosson
mesh_terms: D034861:Abdominal Wall / Q000098:blood supply / Q000601:surgery; D001940:Breast / Q000294:innervation / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D016067:Nerve Transfer; D020127:Recovery of Function; D018570:Risk Assessment; D012677:Sensation / Q000502:physiology*; D012684:Sensory Thresholds; D013524:Surgical Flaps / Q000098:blood supply / Q000294:innervation*; D013697:Thermosensing; D014110:Touch; D016896:Treatment Outcome