Breast sensibility after bilateral risk-reducing mastectomy and immediate breast reconstruction: A prospective study

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Summary

The demand for risk-reducing mastectomy (RRM) to avoid breast cancer has increased over the last several years, and knowledge of the outcome after this prophylactic surgical procedure is important. The primary aim of this study was to prospectively compare breast sensibility before and after RRM in a consecutive series of women. The study also investigated whether the nipples were less numb if the nipple areola complexes (NACs) were spared compared with regrafted nipple tips.

Forty-six women who selected bilateral RRM with immediate reconstruction using implants at the Karolinska University Hospital, Solna, Stockholm, Sweden, were included in the study. The median patient age at the time of surgery was 39 years (range 26–58). All patients were evaluated preoperatively and at least 2 years postoperatively (median 29 months). Tactile, thermal and nociceptive cutaneous sensibilities were studied with quantitative techniques. The patients at the postoperative evaluation completed a questionnaire about subjective feelings in both breasts.

The results showed that breast sensibility is significantly impaired after RRM. Additionally, the ability to experience sexual sensations in the breast is often lost. An NAC-sparing surgery did not result in better nipple sensibility.

Section snippets

Material and methods

Fifty-nine consecutive patients without breast cancer but with an increased risk of developing breast cancer who underwent bilateral RRM with immediate reconstruction with implants at Karolinska University Hospital, Solna, Stockholm, Sweden, between 2004 and 2006 were eligible. Ten patients declined to participate, and three patients had undergone previous breast surgery, i.e., reduction mammoplasty or breast augmentation, and were therefore not included. As many as 46 patients were included in

Quantitative sensory testing

The sensory testing was performed in a quiet room with the patient lying down. Three measuring points on each breast were marked: two points on the skin 2 cm below and above the border of the areola, and a central point on the nipple (Figure 1). The breast skin sensibility was examined with respect to touch, cold, warmth and heat pain. The nipples were examined only for touch sensibility.

Questionnaire about sensibility and sexual feelings

A study-specific questionnaire about subjective feelings in the reconstructed breasts was sent to the patients by mail before the follow-up examination. The patients assessed the feelings in the right and left breasts separately. The questionnaire was completed before the quantitative sensory examination to prevent the results from influencing the answers to the questionnaire. The questionnaire consisted of six items scored using seven points that ranged from 1 (‘Have no sensation’) to 7

Statistical methods

Each value that corresponded to individual yes or no answers for the Optihair von Frey Filaments (MARSTOCK nervtest, Marburg, Germany) was log transformed because a non-linear relationship exists between the von Frey hairs used. The arithmetic means were then anti-log transformed to create a geometric mean. This permitted a better graphic presentation of the results.

A sign test was used to analyse the difference in preoperative perception thresholds and thresholds at follow-up regarding touch,

Results

All 92 breasts of the 46 patients were examined and evaluated. The median time for the postoperative follow-up examination was 29 months (range 24–49). There were no significant differences in the results from the right breast compared with the left breast in any of the investigated parameters.

Discussion

The results of this study show that a severe loss of sensation in the breasts is common after RRM with immediate reconstruction. Anatomical studies have shown that the dominant nerve supply to the breast and NAC comes from the medial and lateral cutaneous branches of the third to fifth intercostal nerves.8, 9 In a skin-sparing mastectomy and reconstruction with implants, the nerve supply is interrupted to the breast both subcutaneously and submuscularly. To study cutaneous somatosensory

Conclusions

Breast sensibility is significantly impaired after RRM, and the ability to experience sexual sensations in the breasts is often impaired or totally lost. The procedures that spared the NAC did not result in better nipple sensibility.

Conflict of interest statement

Jessica Gahm – none.

Yvonne Brandberg – none.

Per Hansson – none.

Marie Wickman – none.

Funding

ALF-grant (Swedish Research Council funding for clinical research in medicine).

Acknowledgements

We thank Elisabeth Berg, MSc., for assistance with statistical analysis and figure preparation.

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Some of the results in this study have been presented at Kirurgveckan, 22–25 August 2011, Visby, Sweden.

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