Clinical Relevance of Sensory Nerve Coaptation in DIEP Flap Breast Reconstruction Evaluated Using the BREAST-Q

INTRODUCTION: Sensory nerve coaptation in autologous breast reconstruction positively affects the sensory recovery in the reconstructed breast. However, patient-reported outcomes are currently lacking and no conclusions on the clinical relevance of nerve coaptation could be drawn. The aim of this study was to evaluate the clinical relevance of nerve coaptation in deep inferior epigastric perforator (DIEP) flap breast reconstruction.

METHODS: A prospective cohort study was conducted with patients with innervated or noninnervated DIEP flap breast reconstruction between August 2016 and August 2018, and completed a BREAST-Q questionnaire at a minimum of 12 months postoperative, in combination with a preoperative questionnaire or at 6 months postoperative. The domain "Physical well-being of the chest" was the primary outcome and patients answered additional sensation-specific questions. Sensation was measured using Semmes-Weinstein monofilaments.

RESULTS: In total, 120 patients were included (65 innervated and 55 noninnervated reconstructions). A clinically relevant difference was found in BREAST-Q scores in favor of patients with innervated reconstructions in general, and for delayed reconstructions in specific. Patients with sensate breast reconstruction more often experienced better and pleasant sensation.

CONCLUSIONS: This study demonstrated that nerve coaptation in DIEP flap breast reconstruction, specifically in delayed reconstructions, resulted in clinically relevant higher patient-reported outcomes for the BREAST-Q domain "Physical well-being of the chest" and that better sensation was perceived pleasantly. However, the BREAST-Q does not adequately address sensation, and the introduction and validation of new scales is required to fill in these gaps to confirm the clinical relevance of nerve coaptation reliably.