Many patients undergo a mastectomy as part of their breast cancer treatment. A mastectomy is a procedure that removes the breast tissue and, in some cases, the breast skin and nipple-areola. During mastectomy surgery, nerves that allow patients to feel (known as ‘sensory’ nerves) are often cut, leaving the patient numb.
Unfortunately, many patients are not told they could end up with a numb chest after their mastectomy, so this often comes as a shock to patients following surgery. This statement was recently echoed by NBC’s Kristen Dahlgren in an article published on Today.com who “…never realized that women who have mastectomies lose feeling in their chests.”
There is some good news though… Thanks to advances in surgical techniques, patients can now maintain or restore feeling following breast cancer surgery.
Sensory Nerve Preservation
The first step in preserving feeling is identifying and protecting the sensory nerves at the time of mastectomy, if the patient’s anatomy and diagnosis allows. During a mastectomy, surgeons must prioritize removing all tissue that looks and feels like breast tissue, otherwise the patient will not get the maximum benefit from the mastectomy in the first place. However, there are steps surgeons can take during the surgery to identify and preserve some of the nerves that provide feeling. However, sometimes this is not possible because of the patients’ anatomy, or because of the location of the breast cancer.
Sensory Nerve Reconstruction
Sensory nerve reconstruction (microneurorrhaphy) is a microsurgical technique designed to reconnect sensory nerves that were cut during the mastectomy. This can be performed with or without a nerve graft.
Most commonly, sensory nerve reconstruction is performed in conjunction with autologous (‘flap’) breast reconstruction procedures like the DIEP flap. However, nerve reconstruction is also possible with implant-based breast reconstruction.
Although the sensation that returns is not usually as good as that provided by Mother Nature before the mastectomy, for most patients, regaining some feeling is far preferable to the alternative of a numb breast.
Unfortunately, at this time, sensory nerve reconstruction is only performed at the time of breast reconstruction and is not offered routinely by all plastic surgeons. Patients must do their research to find a surgeon who offers and regularly performs this procedure.
Breast implants are NOT the only option
The most commonly performed method of breast reconstruction performed today uses tissue expanders and implants. Although this approach is a good option for many, it’s not the only option. Likewise, implants may not be the best option for some patients. Reconstruction options using your own tissue (referred to as autologous or “flap” reconstruction) is also an option. In particular, after radiation treatment flap procedures are associated with fewer complications than implant-based reconstructions.
Sensory nerve reconstruction may be an option
Following a mastectomy, many patients experience permanent numbness to the chest area and reconstructed breast. This is because the sensory nerves that provide feeling are usually cut during the mastectomy. There is some good news though! Advances in breast reconstruction techniques have made sensory nerve reconstruction possible: reconnecting the sensory nerves in the chest can significantly improve the return of feeling to the reconstructed breast.
Enhanced Recovery After Surgery (ERAS) protocols are making recovery easier
Many surgeons are now implementing ERAS protocols to ensure their patients experience an easier recovery following breast cancer surgery, with or without reconstruction. Regardless of the type of reconstruction performed, ERAS protocols are reducing hospital stays, shortening recovery, and reducing the need for narcotics to control discomfort after surgery.
Shared decision-making matters
Breast reconstruction is not a one-size-fits-all procedure. Ensuring you discuss all your options and how they align with your lifestyle, preferences, and goals is critical in planning the best reconstructive option for you.
You can choose NOT to have breast reconstruction
It is important for patients to remember choosing NOT to undergo breast reconstruction and instead opting to “go flat” is an acceptable choice. Going flat (aesthetic flat closure) gives patients seeking no reconstruction the ability to maintain balance and symmetry without reconstructing the breast(s). Women can also choose to go flat after breast reconstruction if they are unhappy with their reconstruction results or have experienced complications after breast reconstruction.
To learn more about ALL your options, download the Breast Advocate App today!