Sensation in Neurotized Deep Inferior Epigastric Perforator Flap Breast Reconstruction With Different Donor Nerves: Comparing T11 and T12.

Overview

abstract

BACKGROUND: The deep inferior epigastric perforator (DIEP) flap can be reliably neurotized for autologous breast reconstruction. In standard fashion, a sensory branch of intercostal nerve T11 or T12 of the DIEP flap is coapted to the anterior cutaneous branch of T3 at the recipient site. In this study, we compare objective sensation recovery and patient-reported sensation, for DIEP flaps innervated by T11 versus T12. METHODS: Patients undergoing neurotized DIEP flap reconstruction after mastectomy were prospectively identified. All nerve coaptation was performed with an allograft between T11 or T12 to T3; the donor nerve was selected by the surgeon based on intraoperative viability and appearance. Sensation testing was performed with a pressure-specified sensory device in the superior, medial, inferior, and lateral quadrants of the breast and at the nipple-areolar complex at specified time points. Patients were additionally invited to complete the Sensation Module of the BREAST-Q postoperatively. RESULTS: Sixty-five neurotized DIEP flaps in 42 patients were included; 35 flaps innervated with T11, and 30 flaps innervated with T12. Preoperative breast sensitivity measurements were comparable between the two groups. In the first 6 months after reconstruction, breasts innervated by T12 were more sensitive in the medial quadrant (P = 0.019). Six to 12 months after reconstruction, the T12 cohort had greater sensitivity in most breast regions (P < 0.05). After 12 months, T12 sensation was superior in the inferior and lateral quadrants (P < 0.05). Postoperative patient-reported breast sensation and breast symptoms were similar, but patients with T12-innervated reconstruction had higher quality-of-life impact BREAST-Q scores, trending toward significance (72 [62-100] vs 62 [48.5-70.25], P = 0.309). CONCLUSIONS: DIEP flaps innervated with T12 have superior sensation recovery compared to flaps innervated with T11. Moreover, patients receiving flaps innervated with T12 report higher quality-of-life relating to breast sensation. When multiple viable donor nerves are available for coaptation, T12 may be the preferred choice due to its superior sensory outcomes.