Can a sensory nerve in the DIEP flap be connected after the flap's been attached to the unilateral mastectomy site?

I had a DIEP flap procedure April 15 and am scheduled for "tweaking" of that breast and changes to the normal breast for symmetry July 23. Before the DIEP procedure I asked about sensory nerve connection and was told it couldn't be done or that they don't do that. Is it too late to do it now? I'm angry to read in a post at this site that it would have been possible. If it is still possible now, should I look for someone who can do it?

Doctor Answers 3

Sensory Recovery in the DIEP Flap

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The best time for sensory nerve repair of the DIEP flap is during an immediate reconstruction at the time of the mastectomy, because the 4th intercostal nerve, which can provide not only sensation to your breast but also erogenous sensation, can be easily located and dissected. At the same time, the sensory branches in the DIEP flap from the intercostal nerve which travels with the DIEP perforators can be singled out, dissected out, and reconnected to the 4th intercostal nerve. In a secondary reconstruction, a lot of these nerve endings once cut and not repaired may be scarred, shortened. Sometimes a nerve graft is necessary which means you have to sacrifice sensation somewhere else to obtain a nerve graft. Thus, it is much more complicated to do a nerve repair during a secondary reconstruction.

Nevertheless, you can still get sensory innervation of your DIEP flaps without nerve repair. More than half of the TRAM or DIEP free flaps regain some sensation starting from the side and midline of the chest through the process of peripheral neurotization, which occurs naturally whenever a sensory nerve is cut.

Sensory restoration and DIEP flap

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There are some surgeons that will attempt to re-attach some sensory fibers, although it is questionable if the sensation is restored to any significant level.  Many do not do it.

DIEP flap sensation

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Studies have been done in Europe that showed even you reattached the nerves the sensation did not return to the levels before surgery.  Don't be angry because of that please. We all rely on the quality of the mastectomy to preserve as much sensation as possible.

Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final type consists of combining any of the above techniques.

If you are interested in being seen in Austin, Georgetown or New Braunfels please give us a call. I know this is a difficult time for you. The majority of my practice is devoted to reconstruction for women with breast cancer or who are BRCA+

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.