Reconstruction Advances Help Restore Sensation in Breast Cancer Patients

Breast cancer is unlike other cancers: Successful treatment isn’t the end of the story. For most patients, some sort of breast reconstruction will follow, and the outcome of that often plays a big role in how a woman sees herself going forward. The good news for patients is that breast reconstruction techniques and alternatives have changed a great deal in the last 15 years. Before that, plastic surgeons often were just trying to fashion something that would “look right” in clothing and more or less fit into a bra.

These days, reconstruction can be very sophisticated. The preferred term is “aesthetic breast reconstruction” because plastic surgeons are concerned not just with shapes and forms under clothing but also with the appearance of the breast unclothed. Reconstruction has become so advanced that it's now more similar to cosmetic surgery.

Restoring Sensation

The most important advances go way beyond appearance. Many people don’t realize how little sensation breast cancer survivors are left with after a mastectomy and reconstruction. A single nerve supplies sensation to the breast, and that nerve passes through tissue that is removed during a mastectomy. Even with “skin-sparing” surgeries that leave skin in place for use in reconstruction, that skin lacks sensation because the nerve was cut.

Neurotization is a new technique that’s restoring sensation to survivors. It allows doctors to re-establish innervation to breast skin using an “allograft,” a nerve from another donor that connects the reconstruction to the chest wall.

Nipple Reconstruction

Form, size and shape all matter in breast reconstruction. And a nipple is a big part of what a breast is supposed to look like. Decades ago, nipple reconstruction was done surgically, by rotating tissue left on top of the newly created breast, sometimes using a skin graft to fashion an areola. Tattoo nipples, which create the surprisingly realistic illusion of a 3-D nipple and don’t show through a T-shirt, were almost unheard of.

Today nipple tattoos are commonplace, with four different providers in Central Florida alone, and much more common than reconstructed nipples. Nipple-sparing mastectomies also are becoming much more common, but up until now there still was usually no sensation. That is changing as advancements have led to the ability to neurotize the nipple.  Microsurgical techniques are used to reattach nipple nerves to lateral chest wall nerves, which increases sensation to the nipple area and decreases post-mastectomy pain syndrome, a little-understood complication that afflicts many breast-cancer survivors.

Live Long and Prosper

Breast cancer is a multidimensional experience: There’s the fear of the cancer itself, but also fear of what a survivor may look or feel like after treatment.

Right or wrong, our society has a strongly held image of women as having breasts. So a plastic surgeon is not only dealing with rebuilding a body but also the emotionally charged question: “Who am I after these surgeries?” It’s very personal and felt deeply by every patient.

As doctors see younger and younger women who have their whole lives ahead of them — early 20s are not uncommon — body image and restoring sensation will continue to grow in importance, to help survivors lead the life they want, on their own terms.