Zhang Casey, Moroni Elizabeth A, Moreira Andrea A
Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
J Reconstr Microsurg. 2024 Nov 29. doi: 10.1055/a-2460-4589.
Breast reconstruction with sensory restoration is gaining recognition as an important goal. Successful reinnervation has been shown in autologous reconstruction but not widely studied in implant-based reconstruction (IBR). This article describes our technique for nipple-areola complex (NAC) neurotization to predict maximal nerve length. We also propose a novel equation that can be utilized preoperatively to estimate the total nerve length required for NAC neurotization.
This is a retrospective study of patients who underwent nerve reconstruction with IBR between April 2021 and May 2022. An equation based on the arc length of a circle was utilized to predict the total nerve length required. Postoperative assessment of sensation was performed at 3, 6, and 12 months using Semmes-Weinstein monofilament testing in all four breast quadrants and the NAC. Patients completed the Breast-Q Sensation Module preoperatively and at 3, 6, and 12 months.
NAC neurotization was performed in 58 patients undergoing IBR. The average length of intercostal nerve (ICN) harvested was 5.3 cm for staged reconstructions and 5.6 cm for direct-to-implant reconstruction. The average total nerve length (allograft + mobilized ICN) was 12.3 cm. On average, 6.9 cm of nerve allograft was used. The mean difference between total nerve length and predicted nerve length was 0.47 cm (range -3.5 to 4.6 cm). There was a significant improvement in sensory monofilament values measured in all four breast quadrants and the NAC between 3 to 6 and 6 to 12 months postoperatively.
A thorough understanding of sensory anatomy and precise surgical techniques are essential to perform NAC neurotization successfully. Our early results suggest the positive impact of breast sensation on patient quality of life.
恢复感觉的乳房重建正日益被视为一个重要目标。自体乳房重建已证实成功进行了神经再支配，但基于植入物的乳房重建（IBR）中对此研究并不广泛。本文描述了我们用于乳头乳晕复合体（NAC）神经化以预测最大神经长度的技术。我们还提出了一个新的公式，可在术前用于估计NAC神经化所需的总神经长度。
这是一项对2021年4月至2022年5月期间接受IBR神经重建患者的回顾性研究。使用基于圆的弧长的公式来预测所需的总神经长度。术后3个月、6个月和12个月，在所有四个乳腺象限和NAC使用Semmes-Weinstein单丝测试进行感觉评估。患者在术前以及术后3个月、6个月和12个月完成乳房-Q感觉模块评估。
58例行IBR的患者接受了NAC神经化。分期重建时，所采集的肋间神经（ICN）平均长度为5.3厘米，直接植入重建时为5.6厘米。平均总神经长度（同种异体移植物+游离ICN）为12.3厘米。平均使用了6.9厘米的神经同种异体移植物。总神经长度与预测神经长度之间的平均差异为0.47厘米（范围为-3.5至4.6厘米）。术后3至6个月以及6至12个月，在所有四个乳腺象限和NAC测量的感觉单丝值有显著改善。
全面了解感觉解剖结构和精确的手术技术对于成功进行NAC神经化至关重要。我们的早期结果表明乳房感觉对患者生活质量有积极影响。
