Introduction: With advances in autologous breast reconstruction remarkable aesthetic form can be provided following mastectomy. Parallel to these improvements in form attendant with the use of autologous tissue has been improvement in texture of the reconstructed breast. However, no attention has been given the sensory deficit present in all current modes of breast reconstruction. This is surprising given the significant attention sensory restoration receives in other anatomic regions of the body. Due to the easy accessibility of appropriate sensory nerves in the operative field, it seemed natural to attempt to provide sensory innervation to autologous flaps that were utilized in post-oncologic breast reconstruction.

Materials and Methods: During a recent thirty-eight month period all women presenting for post-oncologic breast reconstruction, when indicated, were presented the option of autologous innervated breast reconstruction. Detailed discussion of the risks was made and a separate consent form utilized for the neural part of the procedure. All microneurorraphies were performed under operative magnification. Beginning on the eighth postoperative week and continuing bimonthly for 16 months each patient was evaluated for several sensory modalities including touch, two-point discrimination, sharp/dull sensation, and temperature. Data was collected from the native breast skin envelope and the skin island of the flap with the contralateral unoperated breast serving as a control.

Results: Thirteen women underwent innervated autologous breast reconstruction following mastectomy. The mean age of this group was 60.7 years (range 51 to 70 years). There were ten innervated TRAM flaps and three innervated latissimus flaps. All flaps survived. Surgical complications occurred in four patients and include a seroma, abdominal bulging, delayed healing of an abdominal incision and delayed healing of infraumbilical abdominal skin. Sensory testing demonstrated early and sustained return of all modalities throughout the period of data collection. Sensory return approached but never completely attained the levels of the contralateral unoperated breast. There was also a trend for the innervated TRAM flaps to surpass innervated latissimus flaps in degree of sensory return.

Conclusion: Innervated autologous breast reconstruction following oncologic surgery appears safe and efficacious in providing sensory return superior to results reported with non-innervated autologous reconstructions.