Use of Sensory Nerve Provides Feeling in Reconstructed Breast
An innovative procedure performed by surgeons at Baylor College of Medicine in Houston gives breast sensation back to women who have undergone a mastectomy for treatment of breast cancer.
Traditional surgery to remove cancerous breast tissue severs the nerve that supplies sensation to the breast. Using microsurgical techniques, Baylor surgeons at The Methodist Hospital in Houston attach the sensory nerve to a nerve contained in the abdominal tissue used to reconstruct the breast.
"When they regain sensation, patients consider the reconstructed breast to be more natural and accept reconstruction more easily," said Dr. Aldona Spiegel, an assistant professor in the Michael E. DeBakey Department of Surgery at Baylor and a plastic surgeon at The Methodist Hospital.
Spiegel has performed the procedure in about 11 patients in collaboration with Baylor microsurgeons Dr. Saleh Shenaq, professor and chief of the division of plastic surgery and chief of the plastic surgery service at The Methodist Hospital, and Michael J. A. Klebuc, an assistant professor of plastic surgery. Patients begin to feel sensation about three to six months after the nerve connection procedure, Spiegel said. The procedure was developed at the Breast Restoration Center, a joint effort of the department of plastic surgery and the Breast Care Center at Baylor College of Medicine and The Methodist Hospital.
"The reason there is such a lag time is that the nerve has to grow throughout the flap into the skin layers, and the growth rate is about an inch per month," Spiegel said.
Spiegel performs the nerve connection surgery in conjunction with one of two breast reconstruction techniques that use a woman's own abdominal skin and tissue but spare the underlying muscle. The DIEP flap, or deep inferior epigastric perforator, transfers the skin and fat, with the blood supply coming from tiny vessels. The abdominal muscle, not needed for the reconstruction, is left in place.
In a similar, less-invasive procedure called the superficial epigastric artery (SIEA) flap, the blood supply comes from just the fat of the abdominal area. The SIEA flap uses a more shallow incision, however, only 70 percent of patients have blood vessels in the superficial area of the abdomen. Both procedures ease recovery time and allow women to resume an active lifestyle about four weeks after surgery, while creating a natural-looking and feeling breast.
"The abdominal scar can also be well hidden, so most patients will be able to wear a bikini without any scars being visible," Spiegel said.
Not every breast cancer patient facing reconstruction qualifies for the procedure. It takes a longer time to perform, and it requires specially trained microsurgeons to connect the nerves.
"We believe that the new concept in breast reconstruction is restorative surgery, where form including shape, contour, firmess and symmetry, as well as sensation, is achieved," Shenaq said.