Novant Health surgeons restore quality of life for mastectomy patients with reconstruction and sensation-restoration opportunities.

Novant Health’s breast surgery patients have a variety of options to consider alongside a mastectomy: Will they undergo breast reconstruction, and what type, to restore shape? Will they opt in for nerve grafting to restore sensation?

With reconstruction, there are many techniques in use. Blair Wormer, MD, board-certified plastic and reconstructive surgeon at Novant Health Appel & Wormer Plastic Surgery - Myers Park, said that in general, at his clinic and nationally, 85% of patients undergo breast reconstruction with some type of implant. Those procedures are same-day surgeries that fit most patients. Meanwhile, about 15% undergo autologous reconstruction, which uses the patient’s own tissue. This procedure is most beneficial to those who undergo chest radiation. It can be performed either with a deep inferior epigastric perforator (DIEP) flap breast reconstruction, using skin and muscle from the abdomen, or latissimus dorsi (LD) flap breast reconstruction, using skin and muscle from the back.

“When someone has their breast removed, part of their body is being removed, part of their identity is being removed. Our job is to do our best to provide the techniques to people who want it, to restore that part of their body, to bring them quality of life, and make them feel whole again.”

It’s important to Novant Health surgeons to ensure patients know all the options that are available to them. That includes a newly investigated nerve grafting option called Resensation, which in select patients may restore some sensation in a woman’s breast tissue after a mastectomy.

“When we do a mastectomy to remove all the breast tissue and women have simultaneous reconstruction, we try to save as much of the skin as we can – including the nipple and the areola for those who are candidates for a nipple-sparing mastectomy,” said Amelia Merrill, MD, board-certified and fellowship-trained breast surgeon at Novant Health Cancer Institute -Elizabeth and Matthews. “Most women lose the majority of sensation to the breast after a mastectomy as the nerves to the skin are cut during the surgery. The resultant numbness can be problematic for a lot of women; and uncomfortable.

“The breasts may feel as if they are not part of the body,” Dr. Merrill said. “Resensation attempts to restore some of the lost sensation to the skin and improve quality of life. We already have great reconstruction outcomes, so this is one step further.”

“We are trying to restore sensation, and, just as importantly, we’re trying to prevent pain in that area,” Dr. Merrill said. “Pain is very common after mastectomy, and there is a risk of that pain being long-term. Resensation can help prevent the need for further surgery down the road to alleviate that pain.”

For best results, it’s critical that these nerve-grafting techniques are implemented during the mastectomy and reconstruction surgery. “We’re going to have the best opportunity to preserve the patient’s native nerves at the time of the mastectomy,” said Dr. Wormer, who has more than six years of nerve-grafting experience. “This is when we have the freshest injury and the freshest connection, and the shortest distance for new nerve growth to travel.”

That’s why it’s critical for surgeons and referring providers to discuss this combination of options with patients prior to mastectomy. “We cannot go back and do Resensation on another day, because the chances of success are much lower, so let’s have a discussion about this early,” Dr. Merrill said. “We’re always happy to talk.”

If the surgeons select a patient as a potential candidate for Resensation, and their insurance approves this new investigational technique, then Novant Health breast surgeons perform the mastectomy in tandem with a plastic surgeon. Plastic surgeons can identify injured nerves and draw them together with or without a nerve graft. Applying the Resensation technique in this way only adds a moderate amount of time to the surgery and carries an overall low risk. For this reason, Resensation is not a good option for women who have had a mastectomy in the past – their scar tissue complicates the process of identifying damaged nerves. In those cases, nerve grafting may be performed in conjunction with autologous reconstruction to restore sensation to the flap in a delayed reconstruction setting.

Even for women who are not good candidates for Resensation, the technique of identifying damaged nerves during mastectomy may help a breast surgeon’s ability to reduce some chronic postoperative pain.

Patients who do undergo mastectomy with Resensation and reconstruction experience the same recovery process as mastectomy and reconstruction only. Sensation is not restored right away, as nerves regenerate at a growth rate of 1-2 mm per day, so when successful, the effects may start to become apparent between six months to one year.

“Restoring skin sensation to the breasts may improve body image and a woman’s emotional health during a challenging and emotional journey,” “This adds another positive to their recovery process."

- Amelia Merrill, MD

But no matter what care plan they choose with their mastectomy – reconstruction, no reconstruction, Resensation, no Resensation – Novant Health breast surgeons ensure patients feel informed about their options and supported in their choices.

This is still an investigational technique, so we can’t assure it will restore sensation in all patients who undergo it, but we know from the evidence it has a potential benefit with minimal added risk. “We absolutely support women who don’t want to do reconstruction or Resensation,” Dr. Wormer said. “We don’t push it – it’s such an individualistic choice. We make sure to give them all options available to them.”