Spontaneous return of sensibility to the breast often occurs following reconstruction with autologous tissue, according to a study published in the February issue of Plastic and Reconstructive Surgery.
"The spontaneous restoration of sensibility adds so much to the patient's sense of normality," said lead author of the study, William W. Shaw, MD, who is professor and chairman, Division of Plastic and Reconstructive Surgery, UCLA School of Medicine. "After coping with a mastectomy, a patient needs to feel that the reconstructed breast is really part of her body."
The retrospective study included 29 postmastectomy patients who underwent a total of 33 breast reconstructions. The women ranged in age from 36 to 73 years and had undergone reconstruction 7 to 96 months prior to the study. Patients were tested for a variety of sensibilities, including touch pressure, pain, heat or cold, and high- and low-frequency vibration. Each of the tests was performed on the peripheral and central portions of the breast, as well as the nipple and areola. The patients also responded to a questionnaire rating their attitude toward the reconstructed breasts.
All but one patient experienced some restoration of spontaneous sensibility in the reconstructed breast: Sensitivity to touch pressure was evident in 97% of patients; to pain in 88%; to heat and cold in 64% and 82%, respectively; and to high- and low-frequency vibration in 100%. The study showed that sensitivity begins to return within the first year after reconstruction and is even better after 3 years, suggesting that sensitivity continues to improve.
Level of Sensibility Appears to Depend on Reinnervation
The level of sensibility may depend on the reinnervation of the reconstructed breast. This mechanism was not the subject of this study, but it is speculated that the concentration of nerves and sensory receptors within the autologous tissue may determine the level of reinnervation. Reinnervation may be deterred by the condition of the patient's chest wall, including the presence of scars or tissue damaged by radiation treatments.
When a person is unable to feel sensations in a part of the body, like the hand or foot, the limb feels foreign, not like a part of the normal body. In addition, there is a danger of injury if the person cannot feel pain, heat, or cold. The same principles apply for women who have a reconstructed breast, according to Dr. Shaw.
"The sensibility helps a woman incorporate this new reconstruction into her own body image," said Dr. Shaw. "Knowing that restoration can often achieve this level of sensibility, that we can go beyond form alone, we can use this information to help our patients assess the various options available after a mastectomy."
The importance of this sensibility to patients was suggested by their questionnaire responses, which indicate a uniformly high rate of satisfaction. While no statistical correlation can be drawn from this subjective rating, it may be assumed that the high incidence and quality of sensibility was one of the reasons for patient satisfaction.