Breast cancer care is constantly evolving and breast neurotization can provide patients with sensations again, which physicians should consider implementing when discussing surgery outcomes.
Breast cancer care and the aesthetic outcomes of reconstruction are better than ever. Mastectomy options have evolved from breast amputations to partial mastectomy with oncoplastic reconstruction or nipple-sparing mastectomy with reconstruction using implants or autologous tissue.
We’ve come a long way over the years, but the innovation cannot stop there.
Patients need both form and function of their chests. The next step in the evolution of breast cancer care is breast neurotization.
Breast neurotization is the surgical technique that potentially restores sensation to the chest after mastectomy. Loss of sensation happens when nerves are cut and nothing is done to repair them. Because nerves are what help us feel touch, temperature and pain, they play a critical role in our ability to feel connected to the world. Patients living with chest numbness have shared that it often leaves them feeling incomplete, unable to feel the full embrace of a hug. Patients are also at higher risk for everyday injuries, such as burns from heating pads or the sun.
Patients shouldn’t have to accept a numb breast as part of their reality after cancer and neither should we.
If you’re curious about how to start implementing breast neurotization into your practice, here are a few important things to consider.
- Awareness is spreading: Before we started offering breast neurotization, we had a legitimate concern over whether patients would be interested. But we’ve seen that among the breast cancer community, from those with an active diagnosis to previvors looking to act, breast neurotization is a hot topic. Patients are sharing their experiences, learning from each other and wanting to talk about chest sensation with their care teams. Since we started discussing it with our patients, we rarely hear a “no, not interested.” Familiarizing yourself with the technique will better prepare you for your consultations and enable your patients to make the most informed decisions.
- Setting expectations: Nerves are slow to regrow, so regaining sensation can take up to 18 months to 2 years. It won’t be exactly as it was pre-mastectomy. But when the alternative is potentially never feeling their chest again, patients are typically excited and hopeful about the potential to regain some sensation, feeling that it’s important enough to their quality of life to try.
- Breast surgeon: The breast surgeon doesn’t perform the actual technique, but their role during the mastectomy lays critical groundwork for the plastic surgeon to perform the breast neurotization during reconstruction. The breast surgeon identifies which nerves could be candidates for the allograft, preserves as many nerves as possible, and communicates with the plastic surgeon about what they’re thinking and seeing. Surgeons need to be trained in breast neurotization and understand nerve anatomy.
- Plastic surgeon: The plastic surgeon needs to be skilled in microsurgery and experienced with handling and repairing delicate tissue like nerves and vessels. Whether done during autologous reconstructions, implant procedures or aesthetic flat closures, the plastic surgeon typically further dissects the identified nerves and carefully connects a nerve allograft, which operates like a scaffold, enabling the nerve to regrow in the breast.
Better Outcomes are Possible Together
The collaboration between two surgeons is a mindset and a skillset. Consider these three areas that have helped us succeed:
- Trust in each other’s skills: You’re each performing your own role, working together to achieve the best possible outcome, so having trust and confidence in one another is paramount. Structure your roles and where you hand off nerve dissection so that it plays to each other’s skills. Some breast surgeons will be comfortable with nerve dissection, while others may prefer to identify the nerves and then stop, leaving the actual dissection to the plastic surgeon.
- Communication so the best outcome is possible: Starting before the first consultation to the last long-term follow-up, every important detail should be shared.
- A shared vision for the operative plan: This should be discussed and decided upon, including tumor location, incision placement and more, based on the patient’s case and treatment plan before walking into the OR.
We’ve found the procedure to be safe and predictable. As we each became more comfortable with the technique and learned to establish an efficient workflow, breast neurotization now typically adds only 30 minutes or so per side.
We have the power to improve our patients’ safety and well-being, and we have the tools and the skills to do so. Let us keep improving the lives of our patients and continue advancing breast cancer care.
