Regaining Breast Sensation After Mastectomy: Your Questions Answered
Recently, Dr. Pisano answered your questions on regaining sensation after mastectomy via Facebook LIVE. Check out the replay below! Short on time? No worries! You can find quick answers to the top 10 questions asked during our live feed below.
1) When sensory nerve reconstruction is performed during DIEP flap breast reconstruction, how long does it take for sensation to return?
Breast sensation does not return in an instant. Even after sensory nerve reconstruction, the nerves must heal and grow. Typically, sensation takes about a year to return after surgery. Patients may experience some feeling return sooner, and this should improve over time.
2) What is the difference in sensation return when comparing DIEP flap and Implant breast reconstruction?
Sensory nerve reconstruction performed in conjunction with DIEP, SIEA or other tissue flaps provides patients with the best chance to regain sensation after a mastectomy. Nerves are transferred with the tissue and connected to nerves cut by the mastectomy in the chest. When breast reconstruction is performed using implants, some surface sensation may return over time, but will likely be minimal. Implants do not have nerves and so do not allow for nerve reconstruction. In a situation where a tissue flap reconstruction is performed but sensory nerve reconstruction could not be performed, some feeling may still return over time due to the nerve growth from the donor tissue. This is one of the many reasons we favor tissue reconstruction to implants.
3) Can sensory nerve reconstruction be performed at the time of a prophylactic (preventative) mastectomy with immediate DIEP flap breast reconstruction?
Yes! We do it all the time.
4) What is the likelihood of sensation returning after delayed reconstruction with sensory nerve reconstruction?
In the setting of delayed reconstruction, much of the native breast skin has been removed. This means we will use much more abdominal donor skin for the reconstruction. We typically find the flap skin (from the abdomen) will regain sensation but the native breast skin may not.
5) If someone has already had DIEP flap reconstruction and sensation has returned, is it normal to also experience random shooting pains too?
Yes. As sensation returns to the breast, patients may experience shooting pains as nerves “wake up” and this is temporary. However, long term shooting pain may be due to Post Mastectomy Pain Syndrome. One theory is that this arises because nerves cut during a mastectomy try to grow back without any place to go. It can be a real burden for some patients. There is medication available to help, but we have also found patients with Post Mastectomy Pain Syndrome may benefit and find relief from DIEP flap breast reconstruction.
6) If someone is not a candidate for DIEP flap but wants sensory nerve reconstruction, what are their options?
Thigh based tissue flaps offer a great alternative option for those who are not candidates for DIEP flap.
7) If DIEP flap breast reconstruction has already taken place and sensory nerve reconstruction was NOT performed, can a second surgery be performed to reconnect the nerves?
A second procedure to reconnect the nerves is theoretically possible, but is not something we have tried at this time.
8) Does radiation impact the success of sensory nerve reconstruction and the return of sensation to the breast?
The short answer is yes. Radiation affects the native chest wall and tissue and can cause damage to nerves, but patients who undergo tissue flap reconstruction have a better chance of regaining sensation after radiation.
9) Can sensory nerve reconstruction be performed during implant reconstruction?
Potentially. Sensory nerve reconstruction is possible during implant reconstruction for some patients. The use of a nerve graft is always necessary in this scenario however, and at this time, is not covered by insurance.
10) If a patient still has a native nipple, will nipple sensation return?
Nipple-Sparing Mastectomy has been a game changer for breast reconstruction. The sensory nerves travel in the fat layer between the breast tissue and the skin. The amount of sensation a nipple will regain largely depends on how the mastectomy was performed and how much fat the breast surgeon leaves under the breast skin and areola. Even though the sensation that typically returns after nipple-sparing mastectomy is rarely the same as pre-mastectomy, preserving the nipple and areola can significantly improve the amount and degree of feeling that returns.