title: Pilot study of breast sensation after breast reconstruction: evaluating the effects of radiation therapy and perforator flap neurotization on sensory recovery.
abstract: BACKGROUND
  Some sensation to the breast returns after breast reconstruction, but recovery is variable and unpredictable. We primarily sought to assess the impact of different types of breast reconstruction [deep inferior epigastric artery perforator (DIEP) flaps versus implants] and radiation therapy on the return of sensation.
  
  
  METHODS
  Thirty-seven patients who had unilateral or bilateral breast reconstruction via a DIEP flap or implant-based reconstruction, with or without radiation therapy (minimum follow-up, 18 months; range, 18-61 months) were studied. Of the 74 breasts, 27 had DIEP flaps, 29 had implants, and 18 were nonreconstructed. Eleven breasts with implants and 10 with DIEP flaps had had prereconstruction radiation therapy. The primary outcome was mean patient-perceived static and moving cutaneous pressure threshold in nine areas. We used univariate and multivariate analyses to assess what independent factors affected the return of sensation (significance, P < 0.05).
  
  
  RESULTS
  Implants provided better static (P = 0.071) and moving sensation (P = 0.041) than did DIEP flaps. However, among irradiated breasts, skin over DIEP flaps had significantly better sensation than did that over implants (static, P = 0.019; moving, P = 0.028). Implant reconstructions with irradiated skin had significantly worse static (P = 0.002) and moving sensation (P = 0.014) than did nonirradiated implant reconstructions.
  
  
  CONCLUSIONS
  Without irradiation, skin overlying implants is associated with better sensation recovery than DIEP flap skin. However, with irradiation, DIEP flap skin had better sensation recovery than did skin over implants. Neurotization trended toward improvement in sensation in DIEP flaps.
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Magarakis
authors.forename: Raghunandan
authors.initials: R
authors.lastname: Venkat
authors.forename: A Lee
authors.initials: AL
authors.lastname: Dellon
authors.forename: Sachin M
authors.initials: SM
authors.lastname: Shridharani
authors.forename: Justin
authors.initials: J
authors.lastname: Bellamy
authors.forename: Elbert E
authors.initials: EE
authors.lastname: Vaca
authors.forename: Stacie C
authors.initials: SC
authors.lastname: Jeter
authors.forename: Odysseas
authors.initials: O
authors.lastname: Zoras
authors.forename: Michele A
authors.initials: MA
authors.lastname: Manahan
authors.forename: Gedge D
authors.initials: GD
authors.lastname: Rosson
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods; D008875:Middle Aged; D016067:Nerve Transfer; D009558:Nipples / Q000294:innervation / Q000601:surgery; D010865:Pilot Projects; D011184:Postoperative Period; D012677:Sensation; D013524:Surgical Flaps / Q000294:innervation*