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“The prevalence of social media and zoom conferences has led some women to be more self-conscious about how they look,” says Dr. Constance M Chen, plastic surgeon and breast reconstruction specialist. “While our capability to reconstruct a woman’s breast after a mastectomy has come a long way, the emphasis has been on rebuilding her appearance, with less focus on how she feels. In fact, after mastectomy, many women discover that their breasts are numb – a reality for which they were unprepared. The positive news today is that new techniques in breast reconstruction allow specially trained surgeons to reconnect nerves with the possibility of restoring sensation.”
Why the loss of sensation
In a mastectomy the nerves that provide feeling to the breast and nipple are cut, resulting in a loss of sensation in the remaining skin, regardless of whether or not the woman undergoes breast reconstruction. In the case of breast reconstruction using implants, the artificial breast implant may actually form a physical barrier that prevents nerves from growing through it to reach the skin. However, with natural tissue breast reconstruction, microsurgeons can suture together nerves from a woman’s own tissue to create a new sensate breast. In these cases, rejoining blood vessels and nerves allows them to grow through the transferred tissue to reach the skin and increase the potential return of sensation.
There are different types of sensation – deep pressure, light touch, pain, and temperature – and they each come back at different rates. Deep pressure sensation usually returns most quickly and temperature most slowly. Moreover, regenerated nerves can take months or even years to reach the skin, and the quality of sensation is variable. “Since nerve growth is slow and the return of sensation is not ensured, not all surgeons prioritize reconnecting the nerves to restore sensation,” says Dr. Chen. “However, taking the time in surgery to carefully repair the nerves can result in the return of feeling and improved sensation.” Innovative microsurgical techniques that use neural tubes and nerve grafts have provided some patients with excellent sensation and even erectile function of the nipple.
“Restoring sensation is on the frontline in breast reconstruction,” Dr. Chen concludes. “Sensory restoration can help a woman feel more normal after mastectomy. Each woman will have a unique experience and result, but it is important for surgeons to do their best to restore a woman’s body as fully as possible to help her regain her health and sense of self.”
Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Chief of Microsurgery at New York Eye and Ear Infirmary of Mount Sinai. She is also Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. www.constancechenmd.com