When a patient faces a mastectomy, one conversation that needs to happen early is whether to pursue breast reconstruction and sensation preservation. When this conversation starts, patients need help understanding their options and getting connected early with a surgical team capable of delivering advanced, individualized care based on how they want to experience their bodies after recovery.
“It helps to start asking questions such as, ‘Will you want to undergo breast reconstruction, and what type, to restore and possibly enhance shape and size,’” said Amelia Merrill, MD, board-certified and fellowship-trained breast surgeon at Novant Health Cancer Institute in Charlotte. Also: “‘Will you want to consider nerve grafting to restore sensation?’ Our team of surgeons is equipped to guide patients through both decisions.”
At Novant Health, breast reconstruction services are expanding across the system, giving patients access to nationally recognized techniques and expert surgeons without requiring extensive travel. With a full spectrum of implant-based and autologous reconstruction procedures, along with advances in sensation-preserving surgery, Novant Health offers comprehensive solutions tailored to each patient’s needs.
A full range of reconstruction options
Almost half of women who undergo mastectomies as part of breast cancer treatment choose to have breast reconstruction. One study shows that, of those women, the majority prefer implant-based reconstruction, which can involve faster recovery times.
Novant Health offers the latest implant techniques, including pre-pectoral direct-to-implant (pDTI) reconstruction. This process is sometimes referred to as “breast in a day.” The approach requires close collaboration between the breast surgeon and the plastic and reconstructive surgeon and careful patient selection. The breast or breasts are removed while carefully preserving the remaining tissue, so the permanent breast implant can be placed in front of the chest muscle during the same surgery.
pDTI is an efficient way to make a beautiful breast, but there’s no promise of a single surgery, notes Tripp Holton III, MD, a plastic and reconstructive surgeon at Novant Health New Hanover Regional Medical Center in Wilmington. Additional surgeries or procedures can be required should the patient experience an unlikely complication or should they elect to undergo any future procedures to review or refresh their result. Even for patients requiring multiple surgeries with this method, the option to avoid tissue expanders and the additional visits can be quite liberating.
Women who will undergo radiation may be good candidates for autologous tissue reconstruction. Novant Health surgeons perform advanced microsurgical techniques such as DIEP flap (using abdominal skin and fat) and latissimus dorsi flap procedures. These approaches create natural, durable outcomes while reducing long-term complications associated with implants alone.
In addition, oncoplastic surgery is an option for women undergoing lumpectomy. This combined approach — tumor removal with simultaneous reshaping of the breast with maneuvers like a breast lift or reduction — can preserve the nipple and improve cosmetic results. Women may opt to have a mastopexy lift or breast reduction on the day of a lumpectomy to eliminate a second surgery.
One major advancement across reconstruction options is nipple preservation. With better imaging and targeted treatments, nipple preservation is becoming a more common option when there is no cancer in or near the nipple.
“When adequate blood supply is maintained, nipple preservation provides patients with a more natural and aesthetically favorable outcome,” said Blair Wormer, MD, board-certified plastic and reconstructive surgeon at Novant Health Appel & Wormer Plastic Surgery. “Preserving the nipple can also help women feel more like themselves after mastectomy — they haven’t lost every part of their natural breast.”
Innovations in sensation preservation
Generally, mastectomy results in significant loss of breast sensation, which can be both emotional and uncomfortable. Novant Health surgeons are implementing a newly investigated nerve grafting option called Resensation, which in select patients may restore some sensation in a woman’s breast tissue while reducing the risk of long-term postoperative pain.
“The breasts may feel as if they are not part of the body,” 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.”
For optimal outcomes, nerve-grafting techniques should be performed at the time of mastectomy and reconstruction. At this time, the injury to the nerves is freshest and the distance for new nerve growth to travel is the shortest. The chances of Resensation success are much lower after the mastectomy has already been performed.
Early discussions may lead to fewer surgeries and better outcomes
Early conversations between referring physicians and patients about reconstruction and sensation-preservation options are essential when considering mastectomy care. Novant Health surgeons are committed to working with referring physicians to ensure patients are able to make fully informed decisions, connect with the right surgical team, and undergo advanced techniques at the optimal time. By addressing these choices as part of their mastectomy care plan, patients are more likely to achieve better functional and cosmetic outcomes, avoid multiple surgeries and experience a smoother recovery.